Understanding OTIP Insurance and Common Claim Denials

Teachers, educators and support staff in Ontario have stressful jobs. Factors such as a shortage of resources, long working hours, and large class sizes add to the challenges they confront daily.

As a unionized employee with access to a long-term disability benefit plan, you take comfort knowing that you have financial protection provided with your difficult occupation in mind. However, what happens if your claim is unexpectedly denied or your benefits are terminated?

Ontario’s teachers, educational and support staff are covered by a number of insurers including the Ontario Teachers Insurance Plan (OTIP), Manulife, Teachers Life and Sun Life.

Common reasons why Ontario Teachers Insurance Plan (OTIP) and other education workers’ claims are denied

  • Failure to meet the test of disability
  • Disagreement with your doctor’s medical opinion
  • You are not following the insurer’s preferred treatment plan
  • Failure to follow claims procedures correctly
  • Insufficient medical evidence
  • Failure to meet the test of disability
  • Disagreement with your doctor’s medical opinion
  • You are not following the insurer’s preferred treatment plan
  • Failure to follow claims procedures correctly
  • Insufficient medical evidence

Our Services

We provide clear, reliable assistance with insurance claims. If your claim has been denied or delayed, we’ll guide you through the process and offer support every step of the way.

Group Insurance Disability Claims

When illness or injury stops you from working, group disability insurance should provide financial support. If your claim is denied, we’re here to help you get the benefits you’re owed.

Private Insurance Disability Claims

Private disability insurance is a vital safeguard during health challenges. If your insurer denies your claim, our team will fight to ensure you receive the support you deserve.

Loan Insurance Disability Claims

Loan insurance is designed to provide financial relief if you can’t work due to illness or injury. If your claim is rejected, our lawyers are here to challenge the decision and ensure you get the financial protection you deserve.

OTIP and Other Educator Insurance Disability Claims

Educator denied LTD by OTIP or another insurer? We’ll guide you through the process and work to secure the assistance you need to focus on recovery.

HOODIP Insurance Disability Claims

HOODIP insurance is essential for healthcare workers, but denials can happen. We’ll stand up for your rights and help you regain access to your benefits.

CAF/SISIP Insurance Disability Claims

CAF/SISIP insurance supports members of the Canadian Armed Forces. If your claim is denied, we’ll advocate for you to secure the compensation and coverage you’re entitled to.

Critical Illness Insurance Claims

Facing a critical illness is already overwhelming, and a denied claim only adds more stress. Our legal team will carefully review your case, explain your rights, and fight to make sure you receive the coverage you’ve paid for.

Life Insurance Claims

Losing a loved one is always hard, and having a life insurance claim denied only makes things worse. We’re here to help you navigate the claims process and ensure that your family receives the financial support they need.

Travel Medical Insurance Claims

Emergencies while traveling can be expensive, and having a claim denied can make the situation worse. If your travel medical insurance claim is refused, we’ll work to ensure you get the coverage and reimbursement you're entitled to.

Our disability lawyers have handled claim disputes with all insurers covering Ontario’s educational workers

Most of Ontario’s educational workers are covered for long term disability insurance by the Ontario Teachers Insurance Plan (“OTIP”). If you became disabled before January 1, 2020 and are covered under the OTIP policy, Manulife and OTIP adjudicate your benefits. If you became disabled after January 1, 2020 and are covered under the OTIP plan, OTIP insures and adjudicates your benefit claim.

Other teachers and educational workers are covered by Teachers Life or Sun Life Assurance Company of Canada. Regardless of who insures you, we have experience challenging your insurer’s decision to terminate or deny your claim.

Know your rights and act promptly

It is crucial not to delay when it comes to understanding and asserting your rights. Keep in mind that there is a limited timeframe to appeal or contest an insurance claim denial. Act swiftly to protect your interests.

Let our Experienced Lawyers Help

A representative may be available for Ontario teachers to help with the appeal process. You may be required to go through the appeal process before you can take your case to court. We can help you to understand this process so that you are prepared to challenge the decision if it is unsuccessful.

We know the Ontario civil judicial system well, and we have the right expertise to get you the compensation you deserve from your insurer.

Bilingual Disability Lawyers with the Right Expertise to Represent You anywhere in Canada

While our offices are in Toronto, Ottawa, Hawkesbury and Waterloo, we can be by your side and on your side across Canada, handling matters in the Atlantic and Western provinces as well as Northern Ontario. There is no need for you to travel. We come to you, or we handle your case virtually.

Contact us today at 613-233-6898.

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What Our Clients Say

I couldn't be more pleased with the way my case was handled. Eliane was extremely supportive and worked diligently on my case. Her knowledge and guidance led to a pleasing outcome. Thank you to Eliane, her secretary's, reception and anyone else involved in my case. I wish you all the best in the future. Your an exceptional team. I highly recommend Eliane Lachaine.
5 stars
Helen Schutt
My personal experience in dealing with Alison at the firm was outstanding. She was always available to answer any questions or concerns I had in dealing with the insurance company. Alison was always upfront and honest with me about the results we were able to obtain. She worked hard for me and was very aggressive and no nonsense during our mediation meeting. My Ltd carrier made an strong effort to minimize the benifits I was entitled to, but Alison was having none of that. She got the results we were hoping for. I can't thank Alison enough for the help, and respect she gave me throughout the whole process.
5 stars
Lyle Fisher
My interaction with this law firm has been positive from right from the beginning exploratory conversations, which were handled with sensitivity and clarity, to the end result, which I felt was very fair. I was fully informed about possible outcomes as the process unfolded, so there were no surprises. I highly recommend the law firm of Burn Tucker Lachaine.
5 stars
Debby Clarke
I would highly recommend this firm. My lawyer’s composure, knowledge, work ethic and most of all excellent representation put me at ease during this stressful time. My most sincere thanks for a positive outcome. Thank you Alison!
5 stars
Karen T
My experience with being represented by Alison Gilmour was extremely positive. She took the time to know me as a person Alison carefully presented options and enthusiastically supported my decisions.
5 stars
Laurel Mollison
Alison and her team made this process extremely stress free and would highly recommend them to anyone who needs a disability lawyer. She took care of all the works so I could focus on my health.
5 stars
Kaitlynn Friesen
Forever grateful for the exceptional help, care and knowledge from the team at Burn Tucker Lachaine. Highly recommend to contact for any personal injury journey.
5 stars
Kayla P
Had a great experience with the team at Burn Tucker Lachaîne everyone is very pleasant and thoughtful, Colleen great work, definitely will recommend to family and friends.
5 stars
Lindamir Schuchardt
This team of professionals were able to assist me and I would highly recommend them.
5 stars
Lori Toffolo

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