Medical Evidence for Short-Term Disability Claims in Canada

Medical evidence is one of the most important factors in a short-term disability (STD) claim — and one of the most common reasons claims are denied or cut off.

Many people assume that having a diagnosis is enough. In reality, insurers focus less on the name of your condition and more on how your symptoms affect your ability to work.

This guide explains what medical evidence insurers look for in short-term disability claims in Canada, common mistakes to avoid, and what to do if your evidence is questioned.

Why Medical Evidence Matters for Short-Term Disability

Short-term disability benefits are usually paid through employer-sponsored insurance plans. Insurers decide whether you qualify based on the policy’s definition of disability, not just your diagnosis.

Medical evidence is used to determine:

• whether you are unable to work
• how long benefits should last
• whether benefits should continue or end

What Counts as Medical Evidence for STD?

Medical evidence for short-term disability can include:

• doctor’s notes or medical certificates
• clinical notes from treating physicians
• specialist reports (when applicable)
• treatment plans and medication records
• functional ability information

The most important question insurers ask is:

What can this person still do — and what can’t they do — at work?

Diagnosis Alone Is Often Not Enough

One of the most common misunderstandings is believing that a diagnosis automatically qualifies you for STD benefits.

Insurers often accept that:

• you have a medical condition

but still argue that:

• you can perform your job
• your limitations are not severe enough
• there is “insufficient objective evidence”

This is especially common with:

• chronic pain
• mental health conditions
• fatigue-related illnesses
• post-viral or fluctuating conditions

Functional Limitations Matter More Than Labels

Insurers focus heavily on functional limitations, such as:

• inability to concentrate or focus
• cognitive fatigue or brain fog
• physical restrictions (standing, lifting, sitting)
• pain levels that interfere with work
• symptom flare-ups triggered by activity

Medical evidence should connect symptoms directly to job duties, not just list diagnoses.

Common Medical Evidence Mistakes That Lead to Denials

STD claims are frequently denied because of issues like:

• vague doctor’s notes
• missing functional details
• inconsistent medical records
• long gaps between appointments
• returning to work too early
• conflicting statements between forms

Do Insurers Require “Objective Evidence”?

Insurers often ask for objective evidence, even when it may not exist.

This can include:

• imaging results
• lab tests
• formal assessments

However, not all conditions produce objective findings. A lack of objective evidence does not automatically mean a claim is invalid.

Doctors’ clinical observations and consistent treatment records still matter.

Can Surveillance or Social Media Affect Medical Evidence?

Yes.

Insurers may review:

• surveillance footage
• social media activity

They often attempt to compare this information against medical evidence to argue inconsistencies.

How Medical Evidence Affects the Length of STD Benefits

Medical evidence plays a role in:

• whether STD benefits continue
• whether benefits end early
• whether a claim transitions to long-term disability

If medical evidence is unclear or outdated, insurers may end benefits before the maximum STD period.

What If Your Medical Evidence Is Questioned or Rejected?

If an insurer claims your medical evidence is insufficient, it does not necessarily mean the decision is correct.

Depending on the situation, you may be able to:

• clarify medical information
• obtain additional reports
• challenge an early cut-off or denial

Key Takeaway

Strong medical evidence is essential for a successful short-term disability claim — but it’s not just about having a diagnosis.

Clear documentation, consistent treatment, and a focus on functional limitations can make a meaningful difference in whether benefits are approved, continued, or denied.

Understanding what insurers look for can help you avoid common pitfalls.