Long-Term Disability Claim Terminated at 24 Months: What to Do Next in Ontario

The 24-month mark in a long-term disability claim is not a milestone. In the insurance industry, it is a litigation trigger.

Most group LTD policies sold to Ontario employees contain a two-stage definition of disability. For the first 24 months of a claim, you are considered disabled if you cannot perform the essential duties of your own occupation. After 24 months, the definition shifts: you must now be unable to perform the duties of any occupation for which you are reasonably suited by education, training, or experience.

This “any occupation” switch is the single most common reason LTD benefits are terminated. And it is challenged far more successfully than most claimants realize.

Why Insurers Terminate at the 24-Month Mark

The logic insurers use is straightforward. After two years, they commission an “Any Occupation” review — often through a surveillance investigation, a vocational assessment, or another round of Independent Medical Examinations. If they can identify any occupation you are theoretically capable of performing — even a part-time, lower-paying, or sedentary role entirely unrelated to your previous work — they terminate your benefits.

What they do not always acknowledge is that the standard for “any occupation” is not simply physical capability. Courts in Ontario have found that if the occupations identified would require significant retraining, if they pay substantially less than your pre-disability income, or if they are not realistically available to you in the labour market, the “any occupation” test has not been met.

What to Do Immediately After Termination

Request your complete insurance file. Under Ontario law, you are entitled to receive a copy of all documents in your insurer’s file related to your claim. Request it in writing immediately. This file includes the vocational assessments, IME reports, surveillance footage, and internal notes that form the basis of the termination decision. You cannot effectively challenge the decision without knowing what it is based on.

Gather all medical records. Compile complete records from your family doctor, specialists, treating therapists, and any hospital stays related to your condition. Continuity of treatment and consistent medical documentation are the foundation of a successful appeal or lawsuit.

Note the limitation period. In Ontario, you generally have two years from the date of termination — or from the date you discovered the denial was wrongful — to commence a court action. Do not wait to seek legal advice.

Contact a personal injury lawyer immediately. The internal appeals process is not a neutral review. It is conducted by the same insurer that terminated your claim. A lawyer can help you decide whether to pursue internal appeal, skip it, or do both simultaneously depending on your policy terms and timeline.

The Internal Appeal Process

Most LTD policies provide for an internal appeals process. You typically have 30 to 180 days after termination to submit an internal appeal, depending on your policy language.

A strong internal appeal includes:

• Updated medical reports from your treating physicians that specifically address the “any occupation” question
• A functional capacity evaluation (FCE) documenting your physical or cognitive limitations in objective, measurable terms
• Rebuttal evidence responding specifically to the reasoning in the insurer’s termination letter
• Vocational evidence challenging the occupations identified as suitable for you

Be aware: many insurers deny internal appeals as a matter of course. The real value of an internal appeal is not always the insurer’s decision — it is the evidence record you build for subsequent litigation.

Court Action: Suing Your Insurer

If internal appeal fails, or if the timeline makes internal appeal impractical, you can sue your insurer for wrongful termination of LTD benefits. In Ontario Superior Court, you can claim:

• Arrears of benefits from the date of termination
• Ongoing benefits going forward (a declaration that you remain entitled)
• Damages for bad faith, if the insurer’s conduct in handling or terminating your claim was unreasonable
• Legal costs

Bad faith claims are significant. Ontario courts have awarded substantial damages against insurers who conducted unreasonable surveillance, misrepresented policy terms, or denied claims without adequate investigation. If your insurer’s conduct in your file has been particularly aggressive or unreasonable, bad faith damages may substantially increase your recovery.

CPP Disability: The Parallel Application

While pursuing your LTD appeal or lawsuit, apply for Canada Pension Plan Disability (CPP-D) benefits if you have not already done so. CPP-D is a federal disability benefit available to Canadians who have contributed sufficiently to CPP and who have a “severe and prolonged” disability preventing any substantially gainful work.

Important interaction: if you receive CPP-D while your LTD is ongoing, your insurer will typically deduct the CPP-D amount from your LTD benefit. But if you are no longer receiving LTD, CPP-D is a separate and additional income stream. Applying early matters because CPP-D applications frequently require an appeal process of their own.

How Cambria Law Can Help

At Cambria Law Firm, we represent Ontario workers whose LTD benefits have been wrongfully terminated. We review insurance files, build medical evidence records, conduct internal appeals, and litigate against insurers in court when they refuse to pay what our clients are owed.

The 24-month switch is one of the insurance industry’s most profitable termination tools. It is also one that experienced legal counsel challenges successfully, regularly.

Call 416-840-7545 or contact us online for a free consultation. No fees unless we win.