Your LTD Claim Was Denied in Ontario. What Now?
A long-term disability denial is not the final word. Insurers deny valid claims all the time. Here is why, what to do, and the deadline you cannot afford to miss.
Key takeaways
- A long-term disability denial is not the final word. Insurers deny valid claims regularly.
- Common reasons include "insufficient medical evidence," surveillance, and the definition of disability changing after about two years.
- You can often sue the insurer for your benefits, sometimes with additional damages for how they handled the claim.
- Watch the deadline. There is a limitation period, and your policy may impose its own, sometimes shorter, clock.
- Do not let an internal appeal quietly run out your time to sue.
In this article
Getting an LTD denial when you cannot work is frightening, and it is meant to feel final. It is not. Insurance companies are for-profit businesses, and denying or cutting off valid disability claims is common. A denial letter is the start of a fight you can often win, as long as you act in time.
✅Quick answer. A denied long-term disability claim can be challenged, and many denials are overturned. Insurers deny for reasons like "insufficient objective medical evidence," surveillance, or the policy's definition of disability tightening after about two years. You can often sue the insurer for your benefits. But there are strict deadlines, including a limitation period and sometimes a shorter one written into the policy, so get advice quickly.
Is a denial the end of your claim?
No. A denial is the insurer's position, not a neutral ruling. Claims are denied all the time and then reversed once the insurer is properly challenged with the right medical evidence and legal pressure. If you were relying on those benefits to live, do not simply accept the letter.
Why do insurers deny valid claims?
- "Insufficient objective medical evidence", a catch-all the insurer uses even when your doctors support you.
- Surveillance and social media, used to argue you are more capable than you claim.
- The definition of disability changing. Many policies cover you if you cannot do your own occupation for about two years, then switch to a stricter any occupation test, and cut people off at that point.
- Non-compliance, such as allegedly missing appointments or not following treatment.
- Missed deadlines or paperwork, and policy exclusions or pre-existing-condition clauses.
Should you file an internal appeal?
Be careful here. Insurers often invite you to submit an internal appeal, which is reviewed by the same company that denied you. Internal appeals are optional, and while you wait for them, the clock on your legal deadline usually keeps running. People sometimes appeal repeatedly, run out of time to sue, and lose the claim entirely. An appeal can be worth doing, but not blindly and not at the expense of your legal rights.
⚠️The deadline is the trap. There is a limitation period to sue, and many policies contain their own limitation clause that can be shorter. Do not let an internal appeal, or the shock of the denial, eat up your time. Check the deadline early.
Can you sue the insurer?
Yes, and it is often the most effective route. You can sue for the benefits you are owed, and in some cases for additional damages where the insurer handled your claim in bad faith. Many of these cases settle once the insurer is facing a real claim rather than a one-sided paper review.
What should you do now?
- 1.Keep the denial letter and your full policy, including the limitation and definition clauses.
- 2.Gather your medical records and keep your treatment up to date.
- 3.Do not assume an internal appeal protects your deadline. It usually does not.
- 4.Get advice quickly. A free review can tell you your deadline and your options.
If your disability leave also cost you your job, see fired while on medical leave. And note that whether any benefits you do receive are taxable depends on who paid the premiums.
Frequently asked questions
Can I do anything if my LTD claim was denied in Ontario?
Yes. A denial is not final. Many denials are overturned, and you can often sue the insurer for your benefits. But strict deadlines apply, including limitation periods in the policy, so act quickly.
Why did my insurance company deny my long-term disability claim?
Common reasons include claims of insufficient objective medical evidence, surveillance, non-compliance, and the policy's definition of disability tightening from your own occupation to any occupation after about two years.
Should I appeal my LTD denial internally?
Be cautious. Internal appeals are reviewed by the same insurer and are optional, and the limitation clock usually keeps running while you wait. Do not let repeated appeals run out your time to sue. Get advice first.
How long do I have to challenge an LTD denial?
There is a limitation period, and your policy may impose its own, sometimes shorter, deadline. Because it can be tight and starts around the denial, it is important to check it early and not delay.
Omar Haddad
Legal Writer, Mirza Law
Omar Haddad is a legal writer at Mirza Law in Toronto. He writes about termination, medical and disability leave, and what the law protects when an employee is let go.
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