If your long-term disability (LTD) claim has been denied or your benefits were cut off, you may be able to challenge the decision. Insurance companies deny or terminate benefits for many reasons — and some denials are unfair or based on incomplete information. Below, we explain common reasons LTD claims are denied and the main ways people in Ontario try to fight back.
Need help now? Speak with a long-term disability lawyer in Toronto. You can also estimate the potential value of your claim using our Disability Benefits Calculator.
What to Do Immediately After Your LTD Claim Is Denied
- Read the denial letter carefully and note the insurer’s stated reasons for denial or termination.
- Gather and strengthen medical evidence (many denials rely on “insufficient medical documentation”).
- Track deadlines — limitation periods can apply even if you are pursuing an internal appeal.
- Be cautious with forms, releases, or settlement offers before getting legal advice.
Tip: If you are unsure what your insurer is relying on, start by requesting a complete copy of your claim file and the policy/benefits booklet, then speak with counsel about next steps.
Long-Term Disability Denials Are Common
Getting denied can feel shocking — especially when you have medical support and you are doing your best to recover. But denial decisions are not always the last word. Some claims are denied because the insurer says key evidence is missing or because it applies the policy definition of disability in a way you may not agree with. In many cases, people do better when they respond quickly, stay organized, and get guidance on the best path forward.
Common Reasons Why LTD Benefits Are Denied or Cut Off
Start by reviewing your denial or termination letter. Insurers often use similar themes and wording. Common reasons include:
- You are not “totally disabled” under the policy definition
The phrase “totally disabled” can be misleading. It does not usually mean you must be completely incapacitated. Policies often focus on whether you can perform the essential duties of your job (at first), and later whether you can perform any occupation that fits the policy definition.
This becomes even more challenging after the policy changes from an “own occupation” test to an “any occupation” test (often at the 24-month mark). If you are dealing with that change, you may find this helpful: own occupation vs any occupation.
- Insufficient medical documentation
Insurers frequently claim there is not enough medical evidence to support restrictions and limitations. This is especially common with conditions that are harder to measure with a single test (for example, chronic pain, migraines, or mental health conditions). In some cases, strengthening the medical documentation can help — but you also need to protect deadlines while doing so.
- The insurer disagrees with your doctor
Insurers may rely on an in-house clinician or a third-party reviewer who disagrees with your treating providers. Your treating providers typically know your history and day-to-day functioning better than a file reviewer. Disputes about medical evidence are common in LTD cases.
- Surveillance or social media “evidence”
Some insurers use surveillance or online content to argue you can do more than you reported. This can be upsetting, but it is not always decisive — especially where activities are consistent with your limitations or include “good days” that do not reflect your overall condition.
Fighting a Denied LTD Claim
Broadly, people challenge LTD denials in two ways: internally (through the insurer’s appeal process) or externally (through legal action). The right approach depends on your policy, your evidence, and your timelines.
If you are considering an appeal, read this first: appealing an LTD denial. Also review limitation periods and deadlines here: LTD limitation periods and deadlines.
a) Appealing Internally
Internal appeals ask the insurer to reconsider its own decision. Some people choose this route first, particularly if the insurer says it denied the claim due to missing information that can be provided quickly. However, internal appeals can take time, and insurers are not neutral decision-makers. A major risk is spending so long on internal steps that you jeopardize your ability to pursue other options within the required limitation periods.
b) Appealing Externally
External challenges typically involve legal action against the insurer for wrongful denial or termination of benefits. This route can shift the dispute to a process with an independent decision-maker. Many cases resolve through settlement, but every situation is different.
The Deadline to Sue May Be Limited
Limitation periods can apply to LTD disputes, and missing a deadline can seriously affect your options. Do not assume that an internal appeal “stops the clock.” Learn more here: LTD limitation periods and deadlines.
Get the Support of a Disability Lawyer
LTD denials are stressful and time-sensitive. If your benefits have been denied or terminated, you do not have to handle the insurer alone. Monkhouse Law assists employees and individuals with LTD disputes, including denied claims, benefit terminations, and “any occupation” disputes.
Speak with a long-term disability lawyer in Toronto: Long Term Disability Lawyer Toronto or request a free 30-minute phone consultation.
This page is for general information only and is not legal advice. Time limits can apply. If you have questions about your specific situation, consider getting legal advice promptly.
This page was written by Shane Burton-Stoner, a lawyer at Monkhouse Law. Monkhouse Law is a Toronto law firm focused on representing employees and individuals in workplace and disability-related disputes, including long-term disability (LTD) denials and benefit terminations. We offer a free 30-minute phone consultation.