Guide · 15 min read
The Complete Guide to LTD Appeals in Ontario
Last updated: February 2026
When to Appeal vs. Litigate
After receiving a denial, you have two main options: filing an internal appeal with the insurance company, or proceeding directly to litigation. Internal appeals ask the same insurer that denied you to reverse its own decision — which rarely works. Many Ontario disability lawyers recommend skipping the internal appeal entirely and proceeding to litigation, which shifts the power dynamic and forces the insurer to defend its decision under oath.
The Internal Appeal Process
If you choose an internal appeal, you'll need to submit additional medical evidence, a letter challenging the denial reasons, and any supporting documentation. The insurer reviews the appeal — often with the same team or process that denied you initially. Success rates for self-filed internal appeals are very low. However, if your lawyer believes an appeal is the right strategy for your specific case, they will prepare a comprehensive appeal package designed to address every weakness the insurer cited.
Filing a Lawsuit in Ontario
Litigation begins with filing a Statement of Claim in the Ontario Superior Court of Justice. Your lawyer outlines how the insurer breached your policy and what damages you're seeking. The insurer must file a Statement of Defence. Both sides then exchange documents (including the insurer's complete internal file), conduct examinations for discovery (questioning under oath), and attend mediation. Most cases settle at or before mediation.
Limitation Periods
In Ontario, you generally have two years from the date of denial or termination to file a lawsuit. This deadline is strict. Missing it can permanently bar your claim. The sooner a lawyer is involved, the more time they have to build the strongest possible case.
What to Expect at Each Stage
Months 1-3: Retain lawyer, gather medical records, file Statement of Claim.
Months 3-6: Document exchange, insurer discloses internal claim file.
Months 6-12: Examinations for discovery, expert reports, mediation scheduled.
Months 12-18: Mediation and/or trial preparation. Most cases settle before trial.
What Evidence You Need
A strong appeal or litigation case requires: comprehensive treating physician records, specialist opinions, functional capacity evaluations, psychological assessments (for mental health claims), employment records, your complete LTD policy, and the insurer's denial letter and internal file. Your lawyer will identify gaps in the evidence and work with your medical team to strengthen the documentation.