Ontario Disability Lawyers: Short-Term Disability Claims

You're sick or injured and can't work. You've been paying into a disability plan through your employer. Now you need it. But filing a claim isn't as simple as calling in sick.

Short-term disability benefits replace part of your income while you recover. Most plans cover you for anywhere from 15 weeks to 26 weeks. But getting approved requires the right paperwork and medical evidence from the start.

We help people across Ontario file claims correctly and fight denials when they happen.

When Short-Term Disability Applies

STD covers you when you can't do your job because of:

• Serious illness that keeps you off work
• Surgery and recovery time
• Injury from an accident
• Mental health conditions like severe depression or anxiety
• Pregnancy complications
• Flare-ups of chronic conditions

The key question is simple: can you do your job right now? If the answer is no, and you have medical documentation, you should qualify.

How It Actually Works

Most employer plans start paying after a waiting period. Usually one week. Some are longer.

You complete a claim form. Your doctor completes a medical form. Your employer confirms your job details and absence. The insurance company reviews everything and decides.

If approved, you get a percentage of your salary. Usually 60% to 70%. Benefits continue as long as you're unable to work and your doctor supports the claim.

But here's where it gets complicated. Insurance companies will ask for updates. They want to see you're following treatment. They may request additional medical information. And they're always looking for reasons to say you're ready to go back.

Common Reasons Claims Get Denied

• "Insufficient medical evidence" - Your doctor wrote a note saying you're off work, but didn't explain why you can't do your specific job tasks. Insurance companies want functional details, not just a diagnosis.
• "Your condition doesn't prevent you from working" - They claim your restrictions don't match your job requirements. This happens when the medical forms are too vague.
• "You're not following treatment" - Missed appointments or gaps in care give them ammunition to deny you. They expect you to be actively trying to get better.
• "Pre-existing condition exclusion" - If you had symptoms before your coverage started, they might deny the claim. This depends on your policy wording.
• "You didn't submit forms on time" - Most policies have strict deadlines. Missing them can cost you the entire claim.

What We Do

We help you file correctly the first time. The forms seem straightforward but the answers matter. Saying "I'm in pain" isn't enough. We show you how to describe what you can't do and why.

We work with your doctor. Medical professionals focus on treatment, not insurance paperwork. We help them understand what the insurance company needs to see in their reports.

We handle denials. If your claim gets rejected, we review the file, identify the gaps, and build an appeal. Most denials cite vague reasons. We make sure the response addresses exactly what they're looking for.

We protect deadlines. Internal appeals don't always stop the clock on legal deadlines. We make sure you don't lose your right to fight back.

Filing Your Claim - What You Need to Know

Get your forms fast. Contact HR or payroll immediately. Don't wait. Every day counts toward your waiting period.

Fill them out completely. Blank spaces and brief answers invite delays or denials. When they ask how your condition affects your work, give specific examples. Not "I can't focus." Instead: "I can't read client files without losing track. I can't sit through meetings. I need to lie down every two hours."

Your doctor's form is critical. Book an appointment specifically to complete the disability paperwork. Don't expect your doctor to fill it out accurately during a five-minute follow-up. They need to understand your job demands and explain why you can't meet them.

Keep copies of everything. Forms, medical notes, denial letters, correspondence. You'll need them if there's a dispute.

Don't assume HR submitted it. Confirm the insurer received your claim. Get a claim number. Follow up if you don't hear back within two weeks.

If Your Claim Gets Denied

First, request your complete claim file from the insurance company. This shows you exactly why they denied you and what evidence they reviewed.

Second, don't panic. STD denials are common. Many get overturned on appeal if you address the specific reasons cited.

Third, act fast. You usually have a limited time to appeal. In some cases, as little as 30 days. Missing the deadline means you lose the right to challenge it.

Fourth, get your doctor to provide more detail. If they cited insufficient medical evidence, the fix is usually more specific documentation about your functional limitations.

What Your Benefits Are Worth

STD typically pays 60% to 70% of your pre-disability earnings. Some plans have a weekly or monthly maximum. Others deduct Employment Insurance or other benefits.

Check your policy. The exact percentage, maximum benefit, and any offsets should be listed in your employee benefits booklet.

If you're off work longer than the STD period, you'll likely transition to long-term disability. We help you prepare for that shift so there's no gap in coverage.

Working With Insurance Companies

We regularly deal with Manulife, Sun Life, Canada Life, and other major insurers. Each has its own forms, timelines, and review habits.

Some want weekly updates from your doctor. Others send you to independent medical examiners. A few will call you directly for recorded statements.

We prepare you for all of it so your responses are accurate, complete, and don't hurt your claim.

The Biggest Mistakes People Make

• Filling out forms with one-word answers. Insurance companies use brief responses to deny claims. Take the time to explain.
• Stopping treatment too soon. If you feel a bit better, that's good. But stopping appointments or medication before you're fully able to work gives them a reason to cut you off.
• Not following up. If you submit forms and hear nothing for three weeks, call. Don't assume silence means approval.
• Talking to the insurance company without understanding what they're asking for. Recorded calls and questionnaires aren't casual conversations. They're building a file. Every answer matters.

When to Get Legal Help

• If your claim was denied and you don't understand why
• If the insurance company is asking for more information but won't tell you what's missing
• If your doctor supports your claim but the insurer disagrees
• If you're being pressured to return to work before you're ready
• If your benefits stopped suddenly with no clear explanation

We offer a free consultation to review your situation and explain your options. No obligation. Just honest advice about whether you have a case and what it might take to win.

Transitioning to Long-Term Disability

STD usually runs out after 17 to 26 weeks. If you're still unable to work, you'll need to file for long-term disability.

This isn't automatic. LTD has its own application process, forms, and medical requirements. Some policies have a different definition of disability after the STD period ends.

We help you prepare the LTD application while you're still on STD so there's no interruption in benefits. Because running out of STD with no income is a crisis you can avoid.

Why Timing Matters

STD claims have strict deadlines. Most policies require you to file within a certain timeframe from when you stopped working. Miss it and you lose the claim entirely.

Appeals also have deadlines. Usually 30 to 90 days from the denial date. These aren't suggestions. They're hard cutoffs.

If you're considering filing or appealing, don't wait. The clock is always running.

Free Consultation

We offer a free consultation to review your denial or help you file your claim correctly. No obligation. Just practical advice about your situation and what comes next.

If we take on your case, we work on contingency. You don't pay unless we recover benefits for you.

Call us at 905-744-8888 or request a consultation online. We serve clients across Ontario from our Burlington office.