Disabilities That Will Qualify for Long-term disability in Canada
Individuals who are unable to work or manage their financial obligations due to serious health conditions, mental health conditions or disabilities may be entitled to long-term disability benefits in Canada. These benefits are typically paid under an insurance policy and are intended to provide ongoing financial support when employment is no longer manageable.
Claiming long-term disability benefits requires meeting specific eligibility criteria and following a structured application process. While the process can be complex, benefits may be successfully obtained when each step is completed carefully and accurately. To reduce the risk of denial, claimants may benefit from the guidance of experienced legal professionals. At Reyes Tam Law, we offer 100% free consultations to help you understand the process and what you may be eligible for.
Before consulting with counsel, it is helpful to understand the types of disabilities that may be covered under long-term disability insurance in Canada.
What Disabilities come under Long-term disability Benefits in Canada?
The disabilities which qualify for LTD benefits depend on the insurance policy. It typically includes an extensive range of mental and physical health conditions.
1- Neurological Disorders are commonly covered under LTD policies in Canada. These include conditions like multiple sclerosis, epilepsy, and serious diseases that can affect the nervous system. The neurology disorder often causes long-term impairments that can prevent sustained employment.
2- Cardiovascular Diseases: If you are going through heart disease, stroke, or similar cardiovascular conditions, it can cause LTD. It limits the physical strength and takes long recovery times, which makes a sufferer eligible for LTD benefits under many plans.
3- Cancer: Cancer requires a long time for recovery due to its demanding nature of treatment. Cancer patients generally require LTD benefits to manage the medical expenses and extended time off work.
4- Sensory Impairments: Vision or hearing loss comes under sensory impairments. If you are suffering from impairments, you qualify for LTD benefits. It is applicable in situations when you are unable to perform your essential job duties due to sensory impairment.
5- Musculoskeletal Disorders are often covered under LTD benefits. These disorders involve arthritis, chronic backache, and other diseases affecting bones, muscles and joints. It limits the physical ability to work properly, or it makes it difficult or impossible to work.
6- Mental Health Conditions: Nowadays, mental health has also become a matter of concern. It also covers LTD coverage due to its severe impact. From depression, anxiety, bipolar disorder, and other psychiatric conditions, all mental health issues qualify for benefits. The reason is that these issues drastically reduce daily functions and work capacity.
7- Respiratory Disorders: Do you have any respiratory issues? It could be COPD, severe asthma, or other serious breathing issues that limit physical activity. All of the respiratory issues which take a long time to recover come under LTD coverage.
8 – Autoimmune Diseases: Diseases such as lupus and rheumatoid arthritis can cause chronic pain and fatigue, which are covered under LTD benefits. It is because they make the affected ones difficult to maintain regular work.
There is no definitive or exhaustive list of medical conditions that automatically qualify an individual for long-term disability (LTD) benefits in Ontario. Eligibility is determined primarily by the extent to which a medical condition impairs a person’s ability to perform the essential duties of their occupation or any occupation, as defined by the applicable insurance policy.
Certain categories of conditions are commonly associated with approved LTD claims, including the following:
Musculoskeletal Disorders – Chronic pain conditions, severe arthritis, degenerative disc disease, sciatica, and spinal injuries that significantly restrict mobility or physical functioning and interfere with the ability to perform work-related tasks.
Mental Health Conditions – Serious mental illnesses such as major depressive disorder, anxiety disorders, bipolar disorder, post-traumatic stress disorder (PTSD), schizophrenia, developmental and personality disorders, attention-deficit/hyperactivity disorder (ADHD), eating disorders, and substance-related disorders, particularly where symptoms prevent consistent or reliable work performance.
Neurological Disorders – Conditions including traumatic brain injury, brain tumours, cerebral palsy, stroke, multiple sclerosis, Parkinson’s disease, epilepsy, muscular dystrophy, and other disorders of the nervous system that result in cognitive, sensory, or motor impairments.
Cardiovascular Conditions – Severe heart disease, post-stroke limitations, and other cardiac-related conditions that reduce stamina, endurance, or functional capacity required for employment.
Chronic Illnesses – Long-term conditions such as cancer, lupus, fibromyalgia, diabetes, gout, and chronic fatigue syndrome that cause ongoing functional limitations and prevent sustained participation in the workforce.
Ultimately, LTD claims are assessed on a case-by-case basis. Comprehensive and ongoing medical documentation is critical in establishing both initial entitlement to benefits and continued eligibility over time.
How Mental Health Conditions Qualify for Long-Term Disability in Canada?
Mental health conditions can qualify for long-term disability (LTD) benefits in Canada when their severity significantly impairs an individual’s ability to function and maintain employment. Canadian disability benefit systems increasingly recognize mental health on equal footing with physical illness, acknowledging that psychiatric conditions can be chronic, debilitating, and, in some cases, life-threatening.
Common mental health conditions that may support an LTD claim include:
- Depression
- Anxiety disorders
- Bipolar disorder
- Schizophrenia
- Post-traumatic stress disorder (PTSD)
Eligibility, however, is not determined by diagnosis alone. Claimants must provide comprehensive and persuasive medical evidence demonstrating how their condition prevents them from performing the essential duties of their occupation. This typically includes detailed reports from a treating psychiatrist or psychologist explaining the functional limitations caused by the condition, supported by documented symptoms, treatment history, medication records, and evidence of ongoing care. A clear and structured treatment plan prepared by a qualified mental health professional can further strengthen the claim.
Mental health-based LTD claims are often complex and closely scrutinized by insurers. Unlike many physical injuries, symptoms may be less visible and more difficult to quantify, making these claims particularly challenging to navigate. For this reason, individuals pursuing long-term disability benefits for mental health conditions are strongly encouraged to seek legal advice or advocacy support to ensure their claim is properly prepared, supported, and presented.
Chronic Illness and Long-Term Disability Claims
In Canada, long-term disability (LTD) insurance is designed to replace a portion of your income if a medical condition prevents you from working for an extended period. Definitions and specific coverage vary by insurer and policy, but LTD benefits typically depend on whether you can demonstrate, through clear medical documentation, that your condition prevents you from performing your job duties.
Chronic illnesses, including conditions such as diabetes, multiple sclerosis (MS), rheumatoid arthritis, and chronic obstructive pulmonary disease (COPD), are commonly recognized in Canada as conditions that can qualify for LTD benefits when they significantly impair work capacity. LTD policies in Canada often list these types of chronic conditions among those that may lead to successful claims, but coverage is contingent on the severity of symptoms and their documented impact on occupational functioning, not merely the diagnosis itself.
How to Apply for Long-Term Disability Benefits in Canada
A typical process is as follows:
1. Review Your Policy: Familiarize yourself with the terms, definitions, waiting period, and income replacement rates.
2. Gather Documentation: Obtain the health records, reports, and treatment plan from your care provider.
3. Complete Application Forms: Give detailed information about your disability, work history, and how it affects your daily life.
4. Submit your Claim: Follow your insurer’s process (online, by mail, through your employer).
5. Respond to Follow-up: The insurer will likely ask for an independent medical exam or additional information. Respond in a timely manner.
6. Get a Decision: If approved, your benefits will commence according to your policy. If denied, you can appeal the decision.
What Happens if Your LTD Claim is Denied?
Claims are denied every day, for a variety of reasons, including insufficient evidence or disagreements about the severity of the person’s disability.
How Reyes Tam Law Works:
Based in Canada, Reyes Tam Law works with clients across the province who have had their LTD benefits denied.
We will review the denial received from the insurer and will determine if there is a procedural or substantive right to appeal. We will request and review all pertinent medical files before surrendering them to the insurer and obtain additional medical reporting or assessments to support your claim. We will request reconsideration and file the appeal on your behalf, and because Reyes Tam Law works on a contingency fee basis, there are no legal fees until you have received benefits.
If you are going through a difficult financial time and you have lost your benefits, their help can often mean the difference between losing those benefits and being able to obtain the financial assistance you need during difficult times.
Quick Answers on LTD Coverage in Canada That You Should Know
Q: Can mental health conditions be covered under LTD?
A: Yes. Mental health conditions, such as depression and anxiety, can qualify as long as there is medical evidence to support that they are limiting your ability to work.
Q: Are chronic conditions qualified for LTD insurance?
A: Absolutely. Chronic illnesses such as diabetes and multiple sclerosis often qualify as long as they limit your ability to work.
Q: What documents do you need for LTD?
A: Claims typically require detailed medical reports, diagnosis, treatment plans, and supporting evidence of functional impairment.
Q: What if my LTD claim is denied?
A: Consult with Reyes Tam Law on filing for reconsideration or appeal.
Join a Free Consultation with the Professionals of Reyes Tam Law
The long-term disability insurance provides a vital form of income replacement if you become ill or injured and can no longer work. Understanding which conditions are covered and how to navigate the long-term disability claims process allows you to advocate for your own rights.
If your claim is denied, remember, you do not have to go up against the insurance company alone—having professional legal representation will help you in your appeals and recover the benefits you deserve. We are here to provide you with guidance through the tedious process. Book your free consultation with us now