This is a long term disability Ontario guide for 2023. It is based on my experience as a disability lawyer who has helped thousands of people win long term disability payments from insurance companies and government programs.
Let’s dive in.
Long term disability Ontario guide
In this guide, you’ll learn the following:
- What medical conditions qualify for long term disability
- What is disability insurance
- The types of long term disability benefits you may qualify for
- How long term medical leave works
- How much long term disability pays
- How to file a claim for benefits
What qualifies for long-term disability in Ontario?
Any illness or disability can qualify for long term disability (LTD). Insurance companies and government programs don’t approve claims based on a diagnosis; rather, they consider the degree of functional impairments and restrictions caused by your condition or injury. A functional impairment is how your disability prevents you from doing daily activities.
For example, it’s possible to have the diagnosis of Multiple Sclerosis (MS) but NOT meet your insurance policy’s definition of disability. Many people with an early diagnosis of MS can still do the essential duties of their occupation. Therefore, they won’t qualify for long-term disability payments. However, they may qualify later if the MS causes greater functional impairment and limitations.
What is considered a disability in Ontario?
Some medical conditions are more common than others for those approved for long term disability benefits. For example, the most approved group insurance claims are for mental illness (30%), musculoskeletal conditions (21%), cancer (13%), traumatic injuries (9%), nervous system disorders (7%), and all other conditions (13%).
With work-related injuries, the most approved claims in 2020 were sprains and strains (31%), COVID-19 (24%), fractures (7%), cuts, lacerations, punctures (6%), traumatic injuries (6%) and all other conditions (26%).
For more information, check out our article that details what qualifies for long-term disability in canada.
List of Ontario disability benefits
In this section, I review all types of long term disability benefits available in Ontario. If you are looking for a list of all possible benefits, keep reading! I describe each benefit in terms of eligibility, payment amounts and payment duration. So, you should be able to identify benefits for which you may qualify.
There are three sources of long term disability benefits in Ontario:
- Disability Insurance Companies (Private)
- Province of Ontario (Provincial)
- Government of Canada (Federal)
From each of these disability benefits sources (or providers), you get various types of disability benefits.
Below, I review all the types of disability benefits you can get from insurance companies, Ontario provincial agencies and Federal Government agencies.
I will also explain how you can know if you may be eligible for each benefit.
Long-term disability insurance Ontario
Disability insurance companies provide several types of disability benefits that you can qualify for.
Insurance-based plans are managed and paid for by insurance companies. You must be a “covered person” as defined by the policy to be eligible for benefits. This means you enrolled in the plan and paid monthly premiums.
These benefits can be broken into two categories:
- Individual Disability Insurance
- Group Disability Insurance
Let’s go through each category to learn about the different types of benefits.
Individual Disability Insurance
Do you have it? Close to 1 million Canadians have individual long-term disability policies. You can buy individual policies directly from an insurance agent. It is called individual insurance because it only covers you rather than a group.
Individual insurance is popular with high-income individuals, professional service providers, business owners and executives.
These plans will specify the exact monthly payment amount rather than express it as a percentage of your income.
Payment of benefits can be based on income loss rather than a complete inability to work. Payments can last for a specified length of time (2 or 5 years) or until age 65. Some plans can go beyond age 65.
You will know you have this type of plan because you would have bought it from an insurance broker and have been paying premiums.
Because you pay 100% of premiums, there is no income tax charged on long-term disability payments under individual insurance plans.
Group Disability Insurance
Do you have it? To be eligible for short or long term disability benefits, you must be a covered person under a group disability plan. If you have medical, dental and other benefits as part of your employment, then you are likely a member of a group plan. Check to see if that group plan includes disability benefits.
If you have a group benefits plan at work, there is a good chance you are eligible to apply for short and long term disability benefits.
Group insurance is purchased on behalf of a group rather than an individual. The buyer is usually an employer, union, or professional association. Approximately 10 million Canadians have long term disability coverage through group insurance plans.
To have this type of long term disability coverage, you must have enrolled in a group plan through your employment, union, or professional association.
Group insurance plans can have two types of disability benefits:
- short-term disability
- long-term disability
First, group insurance can have short term disability benefits. These benefits pay a percentage of your income (e.g., 70 percent) for a certain length of time (15, 26 or 62 weeks). Approximately 4.6 million Canadians have group short-term disability coverage.
Second, group insurance can include long term disability benefits. These benefits have a waiting period, also known as elimination period. They won’t start until your short-term disability or Employment Insurance Sickness benefits run out. Benefits are intended to cover 60 to 70 percent of your income, up to the maximum dollar amount (e.g. $5,000 max). Therefore, if you are a high-income earner, group LTD benefits can cover less than 60 to 70 percent of your income. You can buy supplemental individual insurance to bring your overall protection to 70 percent of your income.
Group LTD benefits are paid for two years if you can’t perform the essential duties of your own occupation. After that, benefits are only paid if you can’t perform the duties of any occupation. “Any occupation” has a nuanced legal meaning and should not be taken literally. During the any occupation phase, benefits can last until age 65.
It is common for your LTD payments to be reduced by other payments you get, including CPP disability, WSIB, and employment severance. Read your plan carefully because these reductions vary from plan to plan.
Group LTD benefits will be taxable as income if your employer pays some or all of the premiums. If you pay 100% of the premiums, then your benefits will be paid tax-free.
CPP Disability
Do you qualify for it? CPP Disability is only available to people who have worked and paid into the Canada Pension Plan. If you have done this, you can apply and allow Service Canada to determine your eligibility.
The federal government agency Service Canada administers the CPP disability program. It’s one of the long-term disability benefits available to people in Ontario.
To qualify for CPP disability, you must have a physical or mental disability. In addition, it must prevent you from regularly doing substantially gainful work. For the purposes of CPP disability, substantially gainful work means work that pays at least $17,000 or more per year. So, to be eligible for CPP disability, you must have paid into the Canada Pension Plan. So, if you worked, you would have paid in through your payroll taxes. If you qualify, then CPP disability pays a maximum of $1,457 per month (in 2022). This amount increases each year at the rate of inflation. Payments can go until age 65.
Employment Insurance (EI) Sickness
Do you qualify for it? CPP Disability is only available to people who have worked and paid into the Canada Pension Plan. If you have done this, you can apply and allow Service Canada to determine your eligibility.
The Employment Insurance (EI) program pays short-term disability benefits to people who become unable to work. To be eligible, you must be a recent worker who has paid into the EI program. If approved, benefits are 55% of your take-home wages up to a maximum of $638 per week. Benefits are paid for a maximum of 15 weeks.
You cannot get EI Sickness benefits for any weeks that you also qualify for short term disability benefits. If you get EI Sickness benefits and are later approved for short term disability, you will have to reimburse the EI sickness program.
Ontario disability support program (ODSP)
Do you qualify for it? You can be eligible for ODSP simply by being a resident of Ontario. It can potentially apply to everyone. However, you still have to meet the financial and disability requirements.
The Ontario Disability Support Program (ODSP) provides financial support to people who meet the definition of disability under the Ontario Disability Support Program Act.
You must also be in financial need, meaning you and your family do not have enough money to cover your living expenses and have assets within allowable limits.
There is a two-step application for benefits. First, the government will assess whether you meet the financial requirements. If you do, then they will move on to assessing your disability.
If you qualify for benefits, the payment is up to $1,169 per month.
Workplace Safety and Insurance Board (WSIB) of Ontario
Do you qualify for it? WSIB only applies when you have a work-related injury. If you do, then always file an application with WSIB. Let them determine if your WSIB covers your situation. WSIB covers most industries and workplaces in Ontario.
The Workplace Safety and Insurance Board (WSIB) manages Ontario’s workers’ compensation program.
This program pays long-term disability benefits to people when they suffer a work-related injury or illness. So, to be eligible, you must suffer an injury or illness caused by work, and you must be employed with an Ontario employer that is covered by WSIB.
Most employers are covered by WSIB. However, if you’re not sure, WSIB can let you know if your employer is covered. WSIB pays both income loss benefits and medical benefits to people with long-term disabilities.
The income loss payments can go to age 65, but medical coverage can go for life. WSIB benefits are fantastic if you qualify for them.
Disability Tax Credit (DTC)
Do you qualify for it? Anyone in Canada can potentially be eligible for the disability tax credit. You should apply and allow Revenue Canada to determine your eligibility.
Revenue Canada runs the disability tax credit (DTC) program. But unlike the other programs, it does not give a monthly payment. Rather, it gives a refund on federal income taxes paid. So, to get benefits, you need to be paying taxes. Or, you need to be financially dependent on someone who does. In that case, however, the other person receives the benefit — not you.
If you have a child with a long-term disability, then you can qualify for the child disability benefit. With this benefit, you receive a monthly payment from the Federal Government. To qualify, you must be eligible for the Canada Child Benefit. In addition, your child must meet the criteria for the disability tax credit.
Assistance for Children with Severe Disabilities (ACSD)
Do you qualify for it? Any parent, guardian or person over the age of 16 may qualify for ACSD funding. But they must also meet the following requirements:
- Be a Resident of Ontario
- Have a children under the age of 18
- Have a child who have a severe disability which results in a functional loss
- Have a child who lives at home with you
- Have extraordinary costs which are incurred directly as a result of the disability
- Meet the program’s income qualifications
Those who are approved for the ACSD will receive between $25 and $455.00 per month to help support the extraordinary costs related to their child’s disability.
Ontario disability rates 2023
How much is disability in Ontario? Well, the Ontario disability amount differs depending on what program you are applying for. The table below provides a summary of how much each disability program pays.
| Type of Benefit | Amount Paid (2023) | How Long Paid |
|---|---|---|
| Group LTD Insurance | 50 to 85% of your wages | To age 65 |
| Private Insurance | Fixed monthly amount stated in Policy. Amount varies. (e.g., 5,000 per month) | To age 65 or more |
| CPP Disability | $1,078.07 (Average) and $1,538.67 (Maximum) | To age 65 |
| Workers Compensation (WSIB) | 85% of your wages | To age 65 |
| Ontario Disability Support Program (ODSP) | At least $1,308 per month (2023). However, amounts vary depending on your family size, living expenses, and specific situation. | Life, but reduced at age 65 by CPP retirement payments |
| EI Sickness beneifts | You can get 55% of your earnings, with a weekly maximum of $650 | 26 weeks |
Long-term disability insurance rates
How much does long-term disability pay in Ontario? Long term disability benefits are disbursed through two methods: either as a percentage of your salary (typically ranging from 50% to 85%) or as a fixed amount, such as $2,000 per month. These benefits are typically paid on a monthly basis, subject to a maximum payment as specified in your long term disability policy. To determine your 2023 long-term disability benefit payments, consult your plan or speak with your benefits administrator.
CPP disability Ontario rates
In 2023, the basic CPP disability payment amount is $558.74. This is the baseline amount that you could receive from the program. However, Service Canada will increase that amount by how much you paid into the CPP while you were able to work. So, on average, people receive $1,133.71 per month (October 2022). And the maximum someone could receive per month is $1,538.67 in 2023.
ODSP Ontario rates
ODSP payment amounts increase every year according to inflation. For example, on July 1, 2023, they increased by 6.5 percent. So, in 2023, the basic ODSP amount for a single person with the maximum shelter allowance is now $1,308 a month — an $80 increase from 2022.
The table below illustrates the amounts you can expect depending on your household:
Disability Support Program Ontario rates:
| Type of household | Maximum 2022 payment | Maximum 2023 payment |
|---|---|---|
| Single | $1,228 | $1,308 |
| Couple (no children) | $1,839 | $1,960 |
| Couple with two children | $2,233.50 | $2,379.82 |
WSIB long term disability rates
WCB payouts for injuries in Ontario vary depending on your pre-injury take-home pay. However, if approved for WSIB wage loss benefits and your injury took place on or after January 1, 1998, your benefits will cover 85% of your net average earnings (up to an annual maximum).
If your injury is permanent, you may also qualify for permanent medical impairment benefits, which are calculated by multiplying your whole-person impairment percentage by a base dollar value. The base dollar is set out in the WSIA. To determine a non-economic loss benefit, WSIB begins with the base amount corresponding to the year you achieved maximum medical recovery. This base sum is then modified based on your age at the moment of injury. An age adjustment amount is either added for each year under 45 at the time of injury or subtracted for each year over 45, with a cap of 20 years.
To learn more about WCB PMI payout in Ontario, visit WSIB Ontario.
How to apply for long term disability in Ontario
All LTD Ontario plans and programs use basically the same application procedure. The following is a 7-step process you can use to apply for any disability benefit, including LTD in Ontario.
1. Figure out what plan covers you
The first question to ask is whether you worked in the years leading up to stopping work for disability. There are several benefits that are only available to workers.
If you were not in the workforce, then your only option for long term disability is through the Ontario Disability Support Program.
If you are a worker, then it is possible you could be eligible for long term disability benefits through insurance, WSIB or the CPP disability program.
The first question to ask is whether your disability is because of a work-related injury. If yes, then you must apply for workers’ compensation from WSIB. There are short deadlines, and getting this wrong can invalidate your other disability claims. Get legal advice if you are not sure if your disability is work-related.
If you didn’t suffer a workplace injury, then you need to ask if you have group benefits through your employment. If yes, you may have long-term disability coverage under the group plan. Get a copy of your plan booklet and review it to see if you have short and long term disability benefits. Most people are unaware of this coverage.
If you don’t have coverage under a group medical plan, consider if you ever bought an individual disability insurance policy. You would have had to buy this directly from an insurance broker. You would need to be still paying monthly premiums. Go find your copy of the policy or contact the broker who sold it to you.
Next, consider if you paid into the Canada Pension Plan. If you received a paycheck with payroll deductions, then you would have paid into the CPP. If you worked for cash, then you would not have paid into the CPP. You would have coverage for CPP disability benefits if you paid into CPP at least four of the last six years leading up to when you became unable to work. You can be eligible for CPP disability, even if you are also getting benefits from WSIB or a long-term disability insurance company.
Finally, anyone can apply for the Disability Tax Credit.
2. Get support from your doctor
Don’t leave work to apply for disability benefits unless you have your doctor’s support.
You should visit your doctor regularly and explore all options for staying in the workforce. This can include trying treatment aimed at keeping you in the workforce. Or having the doctor reduce your work hours or work duties in order to keep you from having to go off work completely.
3. Get the correct Ontario disability form
Obtain copies of the application forms for the applicable plans or programs. All programs have a notice of claim form and medical report form. Some also require a form filled out by your employer.
The following is a review of where you get the forms for your Ontario disability benefits application:
| Program | Where to Get Application Forms |
|---|---|
| Group Disability Insurance Plan | Your Employer or Plan Administrator |
| Individual Disability Insurance Policy | Your broker or directly from the insurer |
| WSIB | Online or from your employer |
| CPP Disability | Online or from any Service Canada Office |
| ODSP | Online or at any Service Ontario Location |
4. Complete the application forms
You complete the notice of claim form. Take care in filling out the form. It is the foundation of your disability claim. Make sure your answers are complete and accurate. Once you are done, send the form to the benefits provider. This may be done online with some programs (CPP Disability, WSIB) but may have to be done on paper with others (insurance companies).
All programs require a medical report from your doctor. You need to send your doctor a blank copy of the medical report. However, in some cases, there may be a short section of the medical form that you fill out. In either case, arrange for the doctor to get the form. It is usually best to book a medical appointment for the purpose of reviewing this form with your doctor. You can bring the form with you to the appointment. Your doctor then fills out the form and either gives it back to you or sends it directly to the benefits provider.
With long term disability insurance and WSIB, your employer must submit an employer’s report. This is a standard form they fill out. Employers will have copies of these forms, so you don’t have to provide them.
5. Write a cover letter and submit your application
It can be helpful to submit a cover letter with the application forms. This should be a short letter that indicates what documents are attached to your application. You can also use the letter to explain any special circumstances. For example, if you have an important upcoming appointment with a doctor, your letter is the perfect place to inform the benefits provider.
6. Attend an interview with the claim representative
Once your application is complete, the benefits provider will assign a claim representative to your case. This is the person who decides to approve or deny your claim. Usually, the claim representative will want to interview you by phone once they have reviewed everything. This is normal. They want to clarify things and possibly ask for more medical records or information. You should prepare for this call so you can describe your situation accurately. Some claim representatives use this interview to get the information needed to deny your claim.
7. Cooperate and wait for the decision
After the interview, you may need to get more information from the claim representative. It is best to cooperate with them. Try to get the information or records they have asked for. Once you have given all the information, they will decide to approve or deny your claim.
LTD denied? If the provider denies your application, you have the right to ask them to reconsider. This is called an internal appeal. However, we strongly recommend that you consult with us at Resolute Legal or another reputable long term disability lawyer before you submit your appeal. Each appeal needs to be done strategically in order to maximize your chances of success. The right approach for you will be different from what others should do. This is because no two situations are the same.
For more on what sets Resolute Legal apart, check out our long term disability lawyer Canada page.
Having trouble with Ontario long term disability benefits?
Need assistance with your long term disability application? Looking to hire long-term disability lawyer Ontario help to overturn a denial? If so, schedule a free consultation with our disability support team.
Here at Resolute Legal, we specialize in disability claims. We represent clients at all stages of the long term disability claim process, including the transition from work to sick leave, the initial application for benefits, appeals of denied claims and lawsuits for benefits. Call us today to get started on winning back the benefits YOU paid for.
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FAQs
Can you work while on long-term disability in Ontario?
Many individual, own-occupation policies allow claimants to work another job while collecting long term disability for their pre-disability profession. In contrast, most group long term disability policies prohibit working all together. You will need to read your policy to see if working is an option for you.
How long is long term disability in Ontario?
Long term disability payments continue until the claimant is recovered and able to work again or until the coverage period ends, which is usually at age 65 or for a specified number of years. Check your policy or group benefits booklet to see how long your benefits last.
Is LTD mandatory in Ontario?
No. Businesses aren’t required to offer long term disability benefits to their employees. However, many do. Typically, employers will pay a portion of the premium while the employee covers the rest. On the other hand, some employers offer LTD but don’t contribute to the premiums.
