Question 1

How long do I have to file a lawsuit if my STD claim is denied?

Accepted Answer

Under the Limitations Act, 2002 (Ontario), the general rule is two years from the date of the formal denial letter to commence a lawsuit. Internal insurer appeals do not pause this clock. Some special situations: if the insurer has not yet issued a clear formal denial but is delaying indefinitely, the discoverability rule may extend the deadline; if the policy contains a contractual limitation period, it may apply instead — though such clauses face legal scrutiny; if the dispute concerns ongoing monthly benefits cut off mid-stream, separate limitation periods may apply to each missed payment. Get a legal review early.

Question 2

What does it cost to hire a short-term disability lawyer?

Accepted Answer

Most STD disputes are handled on a contingency fee basis — no fee unless we recover compensation for you. The contingency percentage is set in writing at the start of the engagement and typically ranges from 25% to 33% depending on the complexity and the stage at which the matter resolves. Disbursements (court filing fees, expert reports, mediator fees, examination transcripts) are typically advanced by the firm and reimbursed from the eventual settlement. The first 30-minute consultation is free. For wrongful dismissal claims that overlap with STD disputes, contingency arrangements are similar.

Question 3

Can my employer fire me while I'm on short-term disability?

Accepted Answer

The short answer: yes, technically — but with significant restrictions and consequences. Termination during STD triggers ESA notice and severance entitlements, common law reasonable notice (typically far exceeding ESA minimums), Human Rights Code protections against disability discrimination and the duty to accommodate, ESA reprisal protection (if connected to taking statutory leave), and possible aggravated damages for the manner of dismissal. The strongest cases combine wrongful dismissal claims at common law with human rights claims at the Human Rights Tribunal of Ontario. Limitation periods (one year for HRTO, two years for civil claims) require prompt action.

Question 4

My doctor says I can't work but the insurer disagrees. What can I do?

Accepted Answer

This is the most common STD dispute pattern. Strategic responses include: strengthen the medical documentation by working with your physician to produce specific functional limitation reports rather than general “unable to work” notes; obtain specialist confirmation; consider an independent medical assessment from a credentialed specialist to counter the insurer's position; request the insurer's medical reviewer's full report; and consider legal action if the medical evidence is strong and the denial cannot be reversed through additional documentation. Treating physicians' opinions are generally given significant weight by Ontario courts.

Question 5

Does mental illness qualify for short-term disability?

Accepted Answer

Yes. Mental illness is a recognized disability under all Ontario STD policies. Anxiety, depression, bipolar disorder, PTSD, ADHD, OCD, eating disorders, schizophrenia, burnout, and other conditions can all qualify. That said, mental health claims face additional scrutiny — insurers often demand more documentation, question whether symptoms are severe enough to prevent work, argue for work in a different capacity, and apply the “subjective symptoms” framework aggressively. Mental health STD claims succeed when medical documentation focuses on functional impairment (what specifically you cannot do at work) rather than just diagnosis.

Question 6

What if I can do some work but not my full job?

Accepted Answer

It depends on the policy wording. Three patterns appear in Ontario STD policies: total disability requirement (you must be unable to perform any essential duties); substantial disability requirement (inability to perform the essential duties — the core functions, not every task); or partial disability benefits (reduced benefits when you can work partially). If you can do some tasks but not your core job duties, the question becomes whether your inability to perform essential duties meets the policy threshold. Gradually returning to work part-time does not necessarily mean you have recovered; many policies and physicians support gradual return-to-work plans where STD continues on a partial basis.

Question 7

Should I apply for EI sickness benefits if my STD was approved?

Accepted Answer

Most STD policies in Ontario contain language requiring employees to apply for EI sickness benefits, with the EI amount then offset against the STD benefit. The reasoning: EI is a federal benefit you have paid into through payroll deductions. Practical implications: your STD benefit does not change in total; the 1-week EI waiting period applies; reporting requirements apply while receiving EI; tax implications differ; and if STD is later denied, having the EI claim active provides partial income while you appeal or litigate. If your STD policy does not require EI application, applying is often still strategic.

Question 8

The insurer wants me to attend an Independent Medical Examination. Do I have to go?

Accepted Answer

Most STD policies authorize the insurer to require IMEs at reasonable intervals. Refusing without good cause typically results in benefit termination. Strategic considerations: attend the IME (refusal usually means losing benefits); document the experience (note duration, questions asked, testing conducted); bring a support person if needed; request a copy of the IME report; consider an independent rebuttal if the IME is used to deny your claim. Repeated IME requests as a delay tactic can constitute bad faith.

Question 9

What's the difference between short-term disability and long-term disability?

Accepted Answer

STD: 15–26 weeks coverage, “own occupation” disability test, 60–85% income replacement, brief waiting period, transitions to LTD if disability continues. LTD: months to age 65, disability test changes (first 24 months “own occupation,” then “any occupation” — much harder to satisfy), 60–67% income replacement, begins after STD ends. The transition between the two — and the “own-occupation to any-occupation” switch at 24 months of LTD — are major denial points. If you are approaching the STD-to-LTD transition, get legal advice early.

Question 10

Can I work part-time while receiving STD benefits?

Accepted Answer

Most STD policies allow for partial return-to-work arrangements, but rules vary. Common provisions: gradual return-to-work programs (employee works reduced hours during recovery, STD continues partially); earnings offsets (STD benefit reduced by earned income); total disability requirement (some stricter policies disallow any paid work); trial work periods (employee can attempt return without immediately ending benefits). Strategic: coordinate with your physician, get the plan in writing with both employer and insurer, track all earnings carefully, and coordinate with EI if relevant.

Toronto Short-Term Disability LawyerDenied Benefits, Terminated Employees, and the STD-to-LTD Transition

When You Can't Work and the Insurer Says No

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