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OTIP (Ontario Teachers Insurance Plan), also known as OTIP RAEO, is an insurance provider offered to Ontario's educational employees through their group benefits plan. OTIP provides benefits for Long Term Disability (LTD) when teachers find themselves facing a sudden critical illness or injury. PW Lawyers has successfully represented denied OTIP LTD claims, claimants facing OTIP LTD appeals, and other OTIP RAEO denial disputes for long-term disability, critical illness and life insurance policies. Our long-term disability lawyers have a thorough understanding of Ontario's insurance laws and claimant disability rights. We represent clients who have had their long-term-disability (OTIP ltd claims) wrongfully denied or mishandled by OTIP / OTIP RAEO. Teachers and other members of Ontario's educational system deserve to have full access to benefits when facing sudden illness or injury; educational providers deserve to have their disability rights honored and for OTIP's policies' to support teachers when a time of need arises.

PW Lawyers is a legal firm with disability lawyers who are highly knowledgeable and experienced in long-term disability claims. LTD claims are some of the most complex insurance claims that are processed; appealing denied disability claims requires a thorough understanding of insurance technicalities, terms and conditions. Our lawyers not only have the legal esteem, but the medical knowledge to quickly assess a denied long-term disability claim and propose the best legal avenue to gain access to full injury/illness benefits. We provide professional personalized legal services and offer free consultations to anyone facing an OTP LTD dispute.

In this article we will focus on long-term-disability claims by overviewing:

  • OTIP LTD Forms
  • OTIP LTD Claims Process
  • OTIP RAEO denial / OTIP LTD denied claims
  • OTIP LTD Termination
  • OTIP LTD Appeal, and a short introduction into the OTIP Appeals Process
  • When to contact a lawyer for a denied OTIP claim

OTIP Long Term Disability Claims Process

Ontario teachers are offered group benefits from their employers; such benefits include OTIP Long Term Disability coverage. Disability insurance protects teacher's financial wellbeing during a period of being unable to work due to an illness or injury. Income replacement and medical support can help a teacher manage their disability, while maintaining their social and financial foundation.

OTIP defines a long-term disability as:

  • an illness or injury that prohibits you from being able to perform "the significant duties of your regular assignment"
  • an illness or injury that lasts the duration of your policy's waiting period and for an extended period after 24 months (2 years)
  • after the period of 24 months, "...because of illness or injury, you are unable to be gainfully employed"

OTIP LTD Claims oblige you to fill out specific OTIP LTD Forms and follow a specific "OTIP LTD Claims Process". The OTIP LITD claims process demands a strict adherence to filing timelines and deadlines; adherence to such is important for claim approval. The OTIP LTD forms and documents required to be submitted for an OTIP LTD claim include:

  1. Member's Statement
  2. Plan Administrator's Statement
  3. Attending Physician's Statement
  4. Medical Documentation pertaining to your disabling illness or injury (ex. lab reports, physician statements, surgical reports, treatment plans, medical imaging etc.)

If your injury is a result of a motor vehicle accident, OTIP requires you to submit a copy of your car insurance claim and accident report, along with your OTIP LTD Claim. If your injury or illness is a result of your workplace conditions or a workplace incident, and you have filed Workplace Safety and Insurance Board (WSIB) claim, you will need to include all WSIB correspondence and forms you have filed along with your OTIP LTD claim.

The initial forms needed for an OTIP LTD Claim are available through an Ontario teacher's school board, federation, association, or OTIP representative. After submitting the required forms, the entire claim package will be assessed by an OTIP LTD examiner. Once an OTIP LTD claim is approved or denied by the examiner, the decision will be presented to the claimant verbally and in writing. If you do not hear from OTIP within a reasonable amount of time, after submitting an OTIP LTD claim, contact your OTIP representative to gain a better understanding of how your claim is being processed and if a decision of approval or denial has been assigned to the claim.

If you are experiencing reprisal from your employer / administration, or feel that an OTIP service representative is treating you in an inappropriate manner or mishandling your claim, speak with one of our disability lawyers as soon as possible. You should not be enduring this type of treatment during a time of injury or illness.

OTIP RAEO Denial & OTIP LTD Denied Claims

If you are denied OTIP LTD benefits, you are advised to get in touch with your OTIP LTD contact, also known as a Disability Services Representative. If you find out that your claim has been denied, due to any of the following, try and remedy the matter yourself in a timely manner. All administrative or clerical matters can be easily handled:

  • filing error of claim documents (ex. missing specific forms)
  • incompletion of forms
  • wrong information (such as date, policy number, contact information etc.)

If your OTIP LTD claim was denied due to medical reasons, a dispute over the definition of your disability, or disregard for medical documentation and medical statements, we highly suggest you speak to a long-term disability lawyer before you initiate an OTIP appeal for your denied LTD claim. A LTD lawyer who specializes in OTIP claims will be able to assess the reasons for denial, your complete insurance policy's terms and conditions, and your OTIP LTD claim process. With their assessment, they will be able to provide you with the best action plan to get you full access to the OTIP benefits you seek.

Do not feel defeated if you are facing an OTIP RAEO Denial / OTIP LTD Denial; insurance companies ruthlessly deny long-term disability claims in an effort to dissuade claimants and to save the insurance company money. Legitimate disability insurance claims are rejected on a daily basis. PW Lawyers is ready to represent your denied LTD claim, quickening the reconsideration process, and appealing for benefits on behalf of Ontario teacher claimants.

OTIP LTD Termination

If your OTIP long-term disability benefits have been terminated, you should speak to an experienced disability lawyer about your current disability status and continued need for income support. A long-term disability lawyer will see whether your OTIP LTD benefits were prematurely terminated due to incorrect information, or if it was terminated as result of mishandling on OTIP's side.

If OTIP has wrongfully terminated your LTD benefits, an appeal will need to be initiated. It is best to speak with a disability lawyer before you go forth with an appeal on your own; a lawyer will be able to shed light on what medical documents and evidence you need to support your claim in order for it to be approved for extended benefit coverage, as well as address any ways you can get benefit coverage without going through any entire appeal process. This can save you time, money and alleviate mounting stress that can result from dealing with an LTD appeal process.

OTIP LTD Appeals

The OTIP LTD appeal process, let alone any insurance's long-term disability appeal process, requires quick and diligent action. It is important that you initiate an appeal as soon as possible, ready to adhere to any newly imposed timelines and form filing. If your OTIP LTD claim requires more evidence to support your case, you must make sure you gather all documents that can best represent the validity of your disability. There are specific technicalities that may be addressed by an OTIP administrative law judge, or during the appeal hearing. It is important that you do not poorly navigate the appeal process, for your case may be suddenly closed or you may be denied benefits indefinitely.

Speak to a long-term disability lawyer as soon as possible when facing a denied OTIP LTD claim, or if you are already part of an OTIP LTD appeal process. A disability lawyer will advise you on how to successfully manage your LTD appeal and gain access to full benefits in a timely manner. If you are overwhelmed or find that you need help appealing your denied OTIP LTD claim, contact our firm today for a free consultation. We are ready to represent your claim during any stage of an appeal process, allowing you to focus on your health and wellbeing.

For an overview of OTIP RAEO Appeals, please click here.

Our next article will specifically address the topic of OTIP LTD appeals and the OTIP LTD appeal process.

OTIP LTD Denied? Contact A LTD Disability Lawyer For A Free Consultation

Our long-term disability lawyers have successfully represented OTIP claimants who have been denied long-term disability benefits, are in the midst of an OTIP LTD appeal, and are struggling with an OTIP disability dispute.

We provide professional legal services with years of experience and an in-depth knowledge of insurance laws and disability rights. Our legal team understands the sensitivity and urgency of long-term disability claims, as well as the inner workings of insurance companies. We help our clients navigate the convoluted appeal process and fight for their disability rights when their OTIP LTD claim has been wrongfully denied.

No matter where you are located in the province, our lawyers are ready to represent you and your denied OTIP claim. Contact our firm for a free consultation where we can assess your situation and address any questions or concerns you may have. Call our firm directly to book an appointment or fill out an online contact form. We offer consultations in person, over the phone, as well as through video chat.

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otip OTIP LTD Denied? Long Term Disability Claims Long Term Disability Lawyer Toronto & Disability Lawyers, Ontario

Paul Wilkins

Principal Partner

Paul is a member of the Ontario Trial Lawyer’s Association and the Advocates Society. Frequently involved in pursuing his clients’ claims, his areas of focus include statutory accident benefits, short term and long term disability benefits, disability claims and Canada Pension Plan disability benefits.

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