Finding out that your long-term disability (LTD) claim has been denied can feel overwhelming — especially when you’re dealing with a medical condition, financial stress, and uncertainty about your job.
But a denial does not mean you’re ineligible for benefits. Many Long Term Disability Ontario claims denied at first, only to be overturned once the right medical evidence and legal steps are taken.
This guide explains why LTD claims are denied in Ontario, how the process works in this province, and what to do next if your insurance company refuses to pay benefits.
What to Do Immediately After Your LTD Claim Is Denied in Ontario
1. Read Your Denial Carefully
Look for the insurer’s reasons, dates, medical evidence they relied on, and any deadlines.
2. Speak to Your Doctor Right Away
Discuss the denial and ask whether the insurer misinterpreted your condition or functional limitations.
3. Don’t Panic or Try to “Prove Yourself” to the Insurance Company
This can backfire — especially if they are using surveillance or IMEs.
4. Don’t Feel Pressured into an Internal Appeal
Internal appeals are handled by the same insurer who denied your claim. Most are unsuccessful.
5. Get Legal Advice Early
A lawyer can review your denial letter, explain your options, and tell you exactly what to do next.
Why Long-Term Disability Claims Get Denied in Ontario
Insurance companies in Ontario frequently deny LTD claims for reasons like:
1. The Insurer Says You’re Not “Totally Disabled”
Under most Ontario LTD policies, “totally disabled” means you can’t perform your own occupation during the first two years, and then any occupation afterward.
→ Learn more: Total Disability Definition
2. Insufficient Medical Documentation
Missing reports, short appointments, or inconsistent specialist records can be used against you.
3. The Insurer Disagrees with Your Doctor
They may rely on their own assessor, a paper-review doctor, or a functional capacity evaluator.
→ Learn more: IME and Functional Capacity Evaluations
4. A Pre-Existing Condition Clause
Ontario LTD policies often include tighter pre-existing rules.
5. Surveillance
Short video clips can be misinterpreted and don’t show how you feel afterward.
→ Learn more: Surveillance and Long-Term Disability
7. Administrative Issues
Late forms, missing questionnaires, or miscommunication between doctors and insurers.
🔎 For more details, see: Common Reasons for LTD Denial (FAQ)
Ontario’s “Change of Definition” and Denied LTD Claims
Around the two-year mark, Ontario LTD policies typically shift from the “own occupation” test to the “any occupation” test.
This is one of the most common points where claims are denied because the insurer says:
- you can work in a different role
- you can perform sedentary duties
- vocational assessments suggest alternatives
- your restrictions no longer meet the definition
💡 Learn more: Change of Definition LTD in Ontario
Should You Appeal the Denial Internally in Ontario?
Internal appeals are rarely successful in Ontario, and they often delay your case until the two-year limitation period is close to running out.
Internal appeals are risky because:
- they’re not reviewed by a neutral decision-maker
- they require more medical proof than most claimants can collect quickly
- they allow the insurer to delay until the lawsuit deadline passes
- they are handled by the same insurer who denied the claim
💡 Learn more: Appeals and Long-Term Disability Claims
Do You Have to Sue Your Insurance Company?
Most Ontario LTD denials are resolved through legal claims — not internal appeals — because:
- courts are neutral
- lawyers can gather better medical evidence
- insurers are more motivated to settle externally
- very few cases go to trial
✅ Most LTD lawsuits in Ontario settle out of court, providing a lump-sum payment or restoration of benefits.
If Your LTD Claim Is Denied After Being on STD in Ontario
It’s extremely common for insurers to approve STD but deny LTD.
This happens when:
- different departments review STD vs. LTD
- LTD requires more detailed medical evidence
- the “change of definition” is approaching
- the insurer believes you can return to work with modifications
Helpful resources:
Can You Be Forced to Return to Work?
Ontario workers often face return-to-work pressure — sometimes from both the insurer and the employer.
This may include suggestions that:
- you can do “sedentary work”
- your duties can be modified
- you’re medically cleared when you are not
💡 Learn more: Return to Work and Long-Term Disability FAQ
Does Surveillance Affect LTD Denials in Ontario?
Insurers in Ontario regularly use private investigators.
But surveillance is often:
- misleading
- taken out of context
- inconsistent with medical reality
- insufficient to prove a person can work
📷 Real Client Case: Discover how Samfiru Tumarkin LLP used an insurance company’s surveillance report to win compensation for an injured Ontario teacher → Julie Austin vs. OTIP
How a Long-Term Disability Lawyer Helps After a Denial
A disability lawyer in Ontario can take over the entire process so you don’t have to deal with the insurance company again. This includes:
- gathering the strongest medical evidence
- challenging inaccurate IME results
- reviewing and rebutting surveillance
- negotiating a fair settlement
- ensuring you don’t miss the two-year deadline
- handling all communication with the insurer
- protecting you from return-to-work pressure
You focus on your health — we handle the rest.
Important Deadlines: How Long You Have to Appeal an LTD Denial
You have two years from the date of denial to start a lawsuit. If you miss this deadline, you likely lose your right to LTD benefits — permanently.
⚠️ Warning: Insurance companies sometimes encourage repeated internal appeals, which can run out the clock.
What If the Insurance Company Says Your Condition Isn’t Serious Enough?
This often happens with:
- chronic pain
- mental health conditions
- fatigue-related conditions
- migraines
- concussion
- fibromyalgia
- depression or anxiety
- sedentary work limitations
If your doctor supports you, the insurer can’t simply dismiss your symptoms.
Speak to a Long-Term Disability Lawyer in Ontario
If your LTD claim has been denied, getting early advice from a long-term disability lawyer in Ontario can help you understand what went wrong — and what to do next. A disability lawyer can review your denial letter, explain your options, and help you avoid missteps that affect your case.
Many LTD denials in Ontario are overturned once the correct medical evidence and legal arguments are presented. At Samfiru Tumarkin LLP, our team has helped tens of thousands of Canadians through denials and disputes, and we provide clear guidance at every step.
There’s no pressure to proceed — the goal is to give you clarity and confidence about your next step.
✅ Professional Insight: Sivan Tumarkin, who leads our disability law practice, has decades of experience handling LTD denials across Ontario. His background helps our team understand how insurers assess claims — and how to respond effectively.
You don’t pay unless we recover money for you.
📞 Call us at 1-855-821-5900, email help@disabilityrights.ca, or use our online form for a free consultation.
⛔ Our firm handles private and workplace LTD insurance claims, not provincial appeals such as ODSP or WSIB.