There is no list. Which conditions qualify for long term disability is the wrong question, because a group policy does not name diagnoses. It defines disability as an inability, caused by illness or injury, to perform the duties of an occupation, and any condition that produces that inability qualifies. A migraine disorder can qualify and a cancer diagnosis can fail, depending on what the person can still do.
The list that does exist in a policy is the list of exclusions and limitations, and that is the part to read first.
The Policy Defines Disability by Function, Not by Diagnosis
Open the booklet and find the definition. It will read close to this: totally disabled means that, because of illness or injury, you are unable to perform the essential duties of your own occupation.
Every word of it is about capacity. The diagnosis explains the cause and supports the claim, but the claim succeeds by showing the duties and the limitations side by side. That is the reason two people with the same diagnosis get different answers, and it is the reason a well documented file outperforms a serious sounding label.
Own Occupation and Any Occupation Are Two Different Tests
Nearly every group policy pays on the own occupation test for an initial period, commonly two years, and then requires an inability to perform any occupation for which you are reasonably fitted by education, training or experience.
A tradesperson with a shoulder injury may qualify easily under the first test and face a real fight under the second. Knowing which test is in force on the day of the denial decides what evidence is needed, and the chapter on own occupation and any occupation sets out the difference.
Mental Health Conditions Qualify, and Most Policies Limit How Long They Pay
Depression, anxiety disorders, post-traumatic stress disorder and bipolar disorder are all compensable under a group policy. They are also the conditions most group contracts single out for a limitation, often capping benefits for a mental or nervous condition at twenty-four months unless the claimant is hospitalised.
Read the limitation carefully. Where a physical condition and a psychological condition are both present, which one is characterised as the cause of the disability decides whether the cap applies at all.
Chronic Pain and Fibromyalgia Qualify and Are Denied More Often
Chronic pain, fibromyalgia, chronic fatigue and post concussion syndrome are all recognised bases for a disability claim in Canadian law. They are denied at a higher rate because the insurer’s medical consultant reports an absence of objective findings.
The answer is measured function and a consistent treating record over time, not a better scan. The firm’s chronic pain lawyers run these files, and the chapter on why insurers deny sets out the arguments used against them.
Cancer, Cardiac and Post-Surgical Claims Are Approved and Then Reassessed
Active cancer treatment, a recent cardiac event and a major surgery are usually approved without much argument, because the impairment during treatment is obvious and finite.
The dispute comes later. Treatment ends, the file is reassessed, and the insurer takes the position that the claimant has recovered. Persistent fatigue, neuropathy and cognitive effects after chemotherapy are real and are frequently under documented, because the oncology record is about the disease instead of about capacity for work.
Exclusions and Pre-Existing Condition Clauses Do the Work a List Would
The clauses that actually decide entitlement are not about diagnosis either. A pre-existing condition clause excludes a disability arising from something treated or investigated in a defined window before the coverage started. Other clauses exclude self-inflicted injury, war, and disability arising while committing an offence.
These clauses are where an otherwise good claim fails. A single visit to a family doctor months before a new job, for a symptom nobody thought much about, is the fact insurers look for.
The Elimination Period Decides When the Claim Starts
Benefits do not begin at the date of disability. They begin after an elimination period, commonly between ninety and one hundred and twenty days, during which short term disability or sick leave usually applies.
Continuous absence through that period is a condition of the claim. A partial return to work in the middle of it can restart the clock, and the chapter on the elimination period sets out how insurers count it.
Government Benefits Are Not the Same Test
A claimant approved for the Canada Pension Plan disability benefit has met a federal test of a severe and prolonged disability, described on the Government of Canada page for the benefit. That approval is persuasive evidence in a private claim and it is not binding on the insurer.
It also comes with a deduction. Most group policies offset the CPP disability payment against the monthly benefit, and the chapter on CPP disability explains how the offset and the retroactive payment are handled.
Proving That Conditions Qualify for Long Term Disability Takes More Than a Diagnosis
A file that answers the definition contains a treating physician’s report describing limitations rather than symptoms. It contains objective measurement of function where the condition allows it. It contains a record of the attempts to return to work and why each one failed.
If a claim has been denied, the denial letter names the reason the insurer intends to defend. The firm’s long term disability lawyers act for claimants across Atlantic Canada and take these cases on a contingency basis.