Appeals & Litigation
In Ontario, nearly 60% of long-term disability claims are initially denied. Insurers often urge you to appeal directly with them to avoid legal action. However, appealing without professional guidance is difficult and rarely works in your favor. Before filing an appeal, learn your rights—having an experienced disability lawyer behind you maximizes your position at the negotiation table.
Here is what you need to know about navigating the LTD appeals process:
Denied Long Term Disability (LTD) Claim?
To maximize your chances of LTD approval, your claim must be backed by strong clinical evidence. While every case is unique, insurers rely on predictable justifications to deny or cut off benefits. Working with an experienced disability lawyer ensures your file has the strong clinical proof needed to overcome these common hurdles.
Insurers frequently look for reasons to reject claims or lower payouts, often citing:
Common Reasons LTD Claims Are Denied
Late Filling
LTD policies enforce strict deadlines starting from the day you become disabled. Missing your submission or appeal window (usually 180 days from denial) can cause an automatic rejection and permanently cost you your right to file appeal.
Insufficient Medical Evidence
A denial for "insufficient evidence" usually means an internal insurance doctor reviewed your file and disagreed with your treating physician—claiming your condition isn't severe enough to qualify for LTD benefits.
Credibility Issues
Insurers routinely hire investigators to monitor your activity and social media profiles (Facebook, Instagram, TikTok). Public photos or posts showing active moments can easily be taken out of context and used by the insurance company to deny your LTD claim.
Change In definition
LTD policies typically split disability into two phases: Own Occupation (unable to do your specific job for the first 24 months) and Any Occupation (unable to perform any suitable job after 24 months). Insurers often terminate benefits at this 24-month mark by claiming you can work in another field.
Independent medical assessment (IME)
Insurers often require an Independent Medical Examination (IME) by their chosen doctor. Your claim can be denied if the IME doctor decides you are fit to work—or if you refuse to attend the appointment altogether.
Contractual exclusion
The pre-existing condition exclusion allows insurers to deny benefits if you received medical care or advice for your condition before your policy went into effect—usually within a one-year lookback window.
What to Do If the Insurance Company Denies Your Claim
Shortly after filing for LTD benefits, you’ll receive a letter from your insurance company indicating a decision on your claim. If your claim has been denied or terminated for any reason, do not assume that the insurance company is correct in its decision. There could be a variety of reasons why their decision is incorrect and can be challenged.
how to go about fighting the insurance company’s decision.
- Get Professional Legal Help
- Request your file from the insurer
- Appeal decision or litigate
- Review Deniel Letter with your lawyer
- Formulate case, gather and add more evidence
- Track all deadlines closely
Need help right now?
Was your disability claim denied? Don’t face the insurer alone. Contact DisabilityWise today for a free case evaluation. Our experienced advocacy team will screen your file, prepare your documentation, and seamlessly connect you with top-vetted independent Long Term Disability lawyers—all at zero added cost to you.
Legal & Business Disclosure:D-wise is a private, multi-disciplinary disability advocacy, case screening, and file-preparation firm. We are not a law firm, we do not provide formal legal advice, and our internal staff do not act as legal counsel in court. Final legal representation is provided independently by licensed trial lawyers within our co-counsel and professional network. All legal fee-sharing and cost-allocation frameworks comply strictly with provincial Law Society regulations; using our advocacy services will never increase the total legal fee or contingency percentage paid by the client. We are a private entity completely independent of the government, the CRA, and private insurance corporations.