Long-Term Disability Litigation in Sudbury

You may be entitled to a long-term disability (LTD) insurance claim if you’re unable to continue working due to a temporary or permanent disability. Insurance companies often issue denials/terminations and demand additional evidence of your disability. You should consult a qualified disability lawyer as soon as possible and within any applicable limitation period, including any contractual deadlines in your policy. At Paquette & Paquette, we provide legal representation for long-term disability litigation in Sudbury.

Our lawyer, Josée J. Paquette, will help you understand your rights and pursue the benefits you may be entitled to under your policy. She has been practising law with Paquette & Paquette since her call to the bar of Ontario in 2001. If you wait too long to take action against an insurance company for refusing to pay benefits, you may be prevented from asserting a claim. Contact us to review your denial or termination letter and confirm the next steps and deadlines under your policy.

Understanding Long-term Disability Insurance

What Is Long-term Disability Insurance?

Long-term disability insurance is coverage that may replace part of your income if a medical condition prevents you from working for an extended period of time. Many LTD policies begin after a waiting period and continue only while you meet the policy definition of disability.

Who Provides LTD Coverage?

LTD coverage is often provided through:

Employer group benefit plans
Union or professional association plans
Private individual disability insurance policies

How Much Disability Income Can You Expect?

Benefit amounts vary by policy, but many LTD plans replace a percentage of your pre-disability earnings, often around 60% to 70%, up to a monthly maximum. Taxation can depend on who paid the premiums, and some plans reduce LTD payments if you receive other income replacement benefits. Reviewing the policy is the best way to estimate what you may receive.

Eligibility and Medical Conditions

Who Qualifies for LTD Benefits?

Qualification depends on your policy wording and medical evidence. Many policies start with an “own occupation” test, meaning you must show you cannot perform the essential duties of your job. After a set period, some policies switch to an “any occupation” test, which can require proof that you cannot do another reasonable occupation based on your education, training, and experience.

Examples of LTD-related Medical Conditions

LTD claims can involve physical, psychological, or combined conditions. What often matters is not only the diagnosis, but how symptoms create restrictions and limitations that affect work capacity, attendance, focus, stamina, and safety. Conditions that may be involved include the ones listed below, as well as PTSD, migraine disorders, inflammatory conditions, long COVID symptoms, and complications from chronic illness.

Depression, anxiety, nervousness, and mental disabilities
Cancer
Cardiovascular
Chronic fatigue
Fibromyalgia and/or chronic pain
Multiple sclerosis (MS)
Orthopedic
RSD/CRPS

Reasons Your Long-Term Disability Claim May Be Denied or Terminated

If you don’t meet your insurer’s definition of disability
Failure to respond to your insurance company’s requests for:
- Medical examinations
- Documentations
- Information
Medical records that do not clearly describe functional limitations
Missing forms, missed deadlines, or incomplete paperwork
Gaps in treatment or non-compliance allegations
Conflicting medical opinions, including insurer-arranged assessments
A change in the policy definition of disability, such as a switch from “own occupation” to “any occupation”
Surveillance or social media content, the insurer says, is inconsistent with the claimed limitations
Policy exclusions or limitations, such as pre-existing condition clauses

If Your Claim Is Denied or Terminated

What Should You Do If Your LTD Claim Is Denied or Terminated?

Start by requesting the decision in writing and confirming all deadlines. You may also request a copy of your policy and claim file so you can understand what evidence the insurer relied on. Many insurers offer an internal review or appeal process, and success often depends on providing updated medical documentation that explains restrictions, limitations, prognosis, and the impact on your job duties. Keep copies of all communications, and consider legal advice before providing recorded statements or attending insurer-arranged examinations.

Why Hire a Disability Lawyer?

In long-term disability litigation in Sudbury, a disability lawyer can assess whether the evidence meets the policy definition, identify gaps insurers focus on, and help you respond strategically. Legal representation can also help manage deadlines, communicate with the insurer, prepare for mediation, and build the case if litigation is necessary. Talk to us if you want help reviewing the insurer’s reasons and organizing the medical and claim documentation needed to move forward confidently.

What Results Can You Expect from Litigation, and What Are the Odds of Winning?

Outcomes depend on the facts, the policy, and the evidence, and no result can be guaranteed. Many LTD disputes are resolved without a trial through negotiation or mediation. If litigation proceeds, the court will consider the policy language, medical evidence, and credibility when deciding entitlement.

What Makes a Strong Litigation Claim?

Strong claims often include:

Consistent medical documentation that explains functional limits over time
Clear linkage between restrictions and the essential duties of your job
Credible testimony and records that match the reported limitations
Expert evidence, when appropriate, such as independent medical or vocational opinions
Timely action and careful compliance with reasonable insurer requests

How Long Does Litigation Last?

Timelines vary. Some matters resolve in months, while a lawsuit may take a year or more, depending on complexity, evidence, and court scheduling. Many cases settle earlier once the full record is exchanged and reviewed.

It is important that you seek legal advice immediately if your benefits are denied or terminated. Contact us now.