If your long-term disability claim has been denied, you may still have legal options. The steps you take now can affect your ability to recover benefits or compensation.
Many valid disability claims are denied, even when there is strong medical evidence. A denial can be stressful and financially overwhelming, especially when you are unable to work. What matters now is understanding why your claim was denied and what to do next.
Monkhouse Law represents employees only – never insurers. We help clients across Ontario challenge denied, delayed, and terminated LTD benefits. Our lawyers have experience handling long-term disability claims in Toronto and across Ontario and regularly advise employees on denied, delayed, and terminated benefits.
Do not assume the insurer’s decision is final. Speak with a long-term disability lawyer before taking your next step.
Get advice early. Request a free 30-minute phone consultation or call 416-907-9249. You can also use our Disability Benefits Calculator to estimate the potential value of your claim.
Your Options After a Long-Term Disability Claim Is Denied
If your long-term disability claim has been denied, you may have several options depending on your situation:
- Provide additional medical evidence to address the insurer’s concerns (see appealing an LTD denial)
- Submit an internal appeal with the insurance company
- Start a legal claim to recover unpaid benefits or compensation
The right approach depends on your policy, the reason for the denial, and the strength of your medical evidence.
Taking the wrong step can delay or weaken your claim. Speaking with a long-term disability lawyer early can help you determine the best path forward.
What to Do Immediately After Your LTD Claim Is Denied
- Read the denial letter carefully and identify the insurer’s stated reasons for denying or terminating benefits.
- Gather and strengthen your medical evidence, including updated reports from your treating doctors and specialists.
- Track all deadlines closely, as limitation periods may affect your ability to bring a legal claim
- Be cautious with forms, releases, or settlement offers before getting legal advice.
Tip: If you are not sure what your insurer is relying on, request a complete copy of your claim file and your policy or benefits booklet as soon as possible.
Not sure what to do next? Speak with a long-term disability lawyer to understand your options before taking further steps.
Can You Appeal a Long-Term Disability Denial?
In many cases, you may be able to appeal the denial internally with the insurance company or pursue legal action. However, internal appeals are not always the best option. In some situations, they can delay a stronger legal claim or give the insurer more time without resolving the problem.
Before deciding how to proceed, it is important to understand your policy terms, the strength of your medical evidence, and any deadlines that may apply. Getting legal advice early can help you choose the best path forward.
Why Are Long-Term Disability Claims Denied?
Long-term disability claims may be denied for many reasons. Insurers often say there is insufficient medical evidence, that the claimant does not meet the policy definition of disability, or that further information is required.
A denial does not always mean the insurer is right. Some denials happen because the insurer interprets the medical evidence narrowly, relies on incomplete information, or applies the policy in a way that can be challenged.
What Happens After Long-Term Disability Benefits Are Denied?
If your long-term disability benefits are denied, you may have several options depending on your situation, your policy, and how the insurer handled your claim. This can include providing additional evidence, pursuing an appeal, or starting a legal claim.
It is important to act carefully and not assume the insurer’s decision is final. In many cases, the steps you take immediately after a denial can affect the strength of your claim later.
Can You Sue for Denied LTD Benefits?
In some cases, yes. If your long-term disability benefits were wrongfully denied or improperly terminated, you may be able to pursue a claim for unpaid benefits and, in some circumstances, additional damages.
Whether a lawsuit is appropriate depends on the facts of your case, the wording of the policy, the medical evidence, and how the insurer handled the claim.
What Is a Bad Faith Disability Claim in Ontario?
Ontario law requires insurers to handle claims fairly. A bad faith claim may arise where an insurer unreasonably denies benefits, delays payment, fails to properly investigate, or otherwise mishandles a claim.
Under the Ontario Insurance Act, insurers are prohibited from engaging in unfair or deceptive practices.
The Duty of Good Faith
In addition to statutory duties, insurers are also subject to a duty of good faith at common law. This means they must act fairly, honestly, and promptly throughout the claims process.
Courts have recognized that insurers must assess claims with proper regard for the interests of the insured. For example, in W. v. State Farm Mutual Automobile Insurance Company, the court emphasized that insurers must act fairly at every stage of the claims process.
Punitive Damages
Punitive damages may be awarded where an insurer’s conduct is malicious, oppressive, or represents a marked departure from acceptable standards.
These damages are not awarded simply because benefits were denied. There must be evidence of misconduct beyond the denial itself.
In W. v. Pilot Insurance Co., the Supreme Court of Canada upheld a substantial punitive damages award where the insurer acted in a highly improper manner.
Aggravated and Mental Distress Damages
Aggravated damages may be available where the insurer’s conduct causes additional mental distress beyond financial loss.
Long-term disability policies are often treated as peace of mind contracts. Courts have recognized that wrongful denial can cause compensable mental distress in the right circumstances.
For example, in F. v. Sun Life Assurance Company of Canada, the Supreme Court of Canada confirmed that these damages may be available even without a separate independent wrong.
Why Denied LTD Cases Matter
A denial of long-term disability benefits can affect far more than your income. It can affect your health, your recovery, your family, and your ability to remain financially stable during a difficult period.
Without benefits, some employees feel pressure to return to work before they are medically able or face increased stress while trying to navigate the insurer’s process on their own.
Speak to a Long-Term Disability Lawyer
If your long-term disability benefits were denied, delayed, or terminated, you may have legal options.
Acting early can make a difference. Contact Monkhouse Law for a free 30-minute phone consultation to discuss your denied claim with a long-term disability lawyer in Toronto.