Has your long-term disability (LTD) claim been denied or your benefits cut off? You may be told you have “90 days to appeal,” but internal insurer appeals are rarely impartial—and waiting too long can put your legal options at risk. If you’re in Ontario, it’s important to understand the difference between an internal appeal and an external (court) claim, and to get advice early on timelines and strategy.
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Long-Term Disability (LTD) Resources
- Long-Term Disability Lawyer Toronto (Services)
- Long-Term Disability Denied: Common Reasons & What to Do
- LTD Deadlines & Limitation Periods in Ontario (Don’t Miss These)
Long-Term Disability Appeals: Internal vs External
When insurers deny or terminate LTD benefits, they often direct you to an “appeal” process inside the insurance company. In some situations, providing missing medical documentation can help. But in our experience, internal appeals are rarely successful because the insurer is not a neutral decision-maker and has a financial interest in the outcome.
More importantly, internal appeal delays can become dangerous if they cause you to miss key deadlines. For many people, the most effective “appeal” is actually an external claim—meaning pursuing the matter through the courts with legal support.
If you’ve been denied, start with our denial guide: Long Term Disability Denied – Know Your Rights.
Internal appeals (reconsideration with the insurer)
- May involve submitting updated medical records, specialist reports, or functional limitations evidence
- Typically controlled by insurer timelines and insurer-selected reviewers
- Often results in repeat denials, even after additional documentation is provided
External appeals (legal claim / court process)
- Moves the dispute to an impartial decision-maker
- Often leads to settlement discussions before trial
- Helps protect your position if the insurer is delaying or acting unfairly
Need help now? Speak with a long term disability lawyer about strategy and timing: request a free consultation or call 416-907-9249.
Why Internal LTD Appeals Are Often a Trap
Many people don’t realize that insurer “appeals” are not impartial. In practice, the process can function like a delay tactic—waiting, requesting more documents, then denying again after a “suitable” amount of time. This can be especially harmful if it pushes your file toward limitation deadlines.
Insurers commonly define disability narrowly (for example, insisting you are not “totally disabled”) and deny repeatedly even with ongoing medical support. If your benefits were denied or cut off, your first priority should be understanding your deadlines and your best next step—not simply following insurer instructions on autopilot.
For deadlines and limitation periods, read: Long-Term Disability Limitation Periods & Deadlines.
What You Need for a Strong LTD Appeal Strategy
- Get the denial or termination in writing. A written decision helps clarify the insurer’s stated reasons and starts the clock for many deadlines.
- Request your claim file and policy. Your LTD policy wording (and what the insurer says it relied on) matters.
- Build the medical evidence properly. Strong evidence is not just a diagnosis—it’s functional limits, restrictions, treatment compliance, and why you cannot perform your own occupation (or any occupation after the changeover).
- Confirm your limitation period early. Do not assume the insurer’s “90-day appeal deadline” replaces your legal deadlines.
- Get legal advice promptly. The earlier you understand strategy and timing, the better your position.
If your insurer says you can do “any occupation” after two years, see: Own Occupation vs Any Occupation (LTD Test).
Ontario Case Law: Deadlines, “Clear Denials,” and Missed Appeal Periods
K. v. Sun Life (2014 ONSC 1523): When “Ambiguous” Letters Matter
In K. v. Sun Life Assurance Company of Canada, the insurer raised a limitation argument based on timing. The insured’s lawyer argued that parts of the insurer’s correspondence used ambiguous language that did not clearly and unequivocally deny the claim. The court agreed the wording left room for interpretation and held that a limitation period may not start running until there has been a clear denial of benefits.
D. v. RBC Life (2015 ONCA 641): Relief from Forfeiture and Late Proof of Claim
In D. v. RBC Life Insurance Company, the insurer denied LTD benefits because the insured did not submit proof of claim within the policy’s stated timeline. The case examined whether the insured could obtain relief from forfeiture in the circumstances. The court applied a legal test and ultimately found the insured had not forfeited the right to benefits, emphasizing how technical issues can be outcome-determinative in LTD disputes.
Why this matters: LTD disputes can turn on deadlines, wording in denial letters, policy terms, and technical legal arguments. Getting advice early can help protect your claim and avoid preventable mistakes.
Common Reasons LTD Benefits Are Denied or Cut Off
LTD denials and terminations happen for many reasons, including:
- Allegations of not being “totally disabled”
- Claims of insufficient medical evidence (especially for “invisible” disabilities)
- Disagreement between insurer assessors and your treating physicians
- Surveillance or functional testing disputes
- “Any occupation” changeover after 24 months
For a full breakdown, read: Long Term Disability Denied – Know Your Rights.
Talk to a Long-Term Disability Lawyer
If your LTD claim was denied or your benefits were cut off, you do not have to navigate the insurer’s process alone. The sooner you get advice, the easier it is to protect your timelines, organize evidence, and choose the strongest strategy.
Next step: Visit our service hub for LTD disputes: Long-Term Disability Lawyer Toronto.
Request a free 30 minute phone consultation or call 416-907-9249
Monkhouse Law represents employees and individuals in long-term disability disputes, including denied claims, benefit terminations, and “any occupation” disputes. We do not represent insurers.