A disability claim begins with the policy and the work you can no longer sustain.

Some policies assess whether the person can perform their own occupation for an initial period and a different suitable occupation later. Others use different language. Read the definition, elimination period, exclusions, offsets and proof requirements together. Ontario’s Insurance Act also contains statutory conditions that can apply to accident and sickness insurance contracts.4

A diagnosis does not always explain whether someone can sustain attendance, concentration, pace, lifting, decision-making or interpersonal demands. The treating record is more useful when it describes restrictions, variability, prognosis and treatment response.

The work evidence should describe the real job—not only the title. Travel, deadlines, screen time, shift length, safety obligations and unpredictable demands may all matter.

Identify the policy definition applied, the effective date, the evidence relied upon, any missing information and the review process offered. A surveillance note or insurer medical opinion should be considered in the context of the full record.

When benefits are denied or stopped, an internal appeal and a legal claim are different paths. The better next step depends on the reason, the evidence and the timing.

Ontario’s Limitations Act, 2002 sets a basic two-year period from discovery, subject to the full statutory analysis.1 The Court of Appeal has held that an insurer does not have a common-law duty to tell an insured about the limitation period.2

The Court has also rejected a rule that a denial must always be “clear and unequivocal” before the limitation analysis begins.3 The policy communications and claim history need to be reviewed promptly.

A premises claim needs more than proof that someone was hurt. Legal work may have to identify the correct owner, occupier or contractor and preserve evidence before the condition changes.

• Identify the people and organizations responsible for the property.
• Protect short notice requirements and disappearing maintenance evidence.
• Connect the mechanism of the fall to medical and functional loss.

See the Ottawa slip-and-fall claim strategy →