If your long-term disability (LTD) claim was denied or your benefits were cut off, you may be able to challenge the decision.
Insurance companies deny or terminate LTD benefits every day — often even when a doctor says you can’t work. Many denials are based on strict policy wording, selective evidence, or insurer file reviews, not your real life limitations.
The key is understanding what the denial really means — and what to do next.
This guide explains:
- why LTD claims are denied in Canada
- what those denial reasons actually mean
- what to do immediately after a denial
- why internal appeals often fail
- how long you have to take action
- how a long-term disability lawyer can help
⚠️ Important: Don’t Delay After an LTD Denial
If you’ve received a denial or termination letter, time matters.
Many people assume that following the insurer’s internal appeal process protects their rights. In reality, limitation periods often continue to run, and delays can permanently affect your options.
What Counts as a Long-Term Disability Denial?
An LTD denial doesn’t only mean your initial application was refused.
In Canada, a denial can include:
- your initial LTD claim was denied
- benefits were approved, then later cut off
- the insurer says you no longer meet the definition of “disabled”
- benefits stopped after the two-year change of definition
- the insurer claims you can work in another occupation
- your claim was terminated after surveillance or an IME
- benefits ended due to alleged paperwork or compliance issues
What to Do Immediately After Your LTD Claim Is Denied
If your long-term disability claim was denied or terminated:
Step 1: Read the Denial Letter Carefully
Pay attention to:
- the insurer’s stated reasons
- dates and timelines
- medical evidence they relied on
- any deadlines mentioned
Step 2: Do Not Try to Prove Yourself to the Insurer
Avoid:
- sending documents on your own
- writing explanations without advice
- agreeing to more assessments right away
These steps are often used against claimants later.
Step 3: Speak With Your Doctor
Confirm whether your doctor disagrees with the insurer’s conclusions and ensure your functional limitations are clearly documented.
Step 4: Get Legal Advice
A long-term disability lawyer can quickly tell you:
- whether the denial is legally defensible
- whether evidence was misinterpreted
- what strategy best protects your claim
Common Reasons LTD Claims Are Denied (and What They Really Mean)
Insurance companies rely on policy language and internal reviews, not your day-to-day reality.
“You Are Not Totally Disabled”
This is the most common reason for denial.
“Totally disabled” does not mean bedriddent or incapable of all activity. Policies usually focus on whether you can perform the essential duties of your job, and later whether you can perform any occupation under the policy definition.
Insufficient Medical Evidence
Many denials are framed as “not enough medical documentation,” especially for conditions that are harder to measure with a single test.
This often reflects how evidence is written, not whether you are actually disabled.
The Insurer Disagrees With Your Doctor
Insurers frequently rely on:
- in-house medical consultants
- paper file review
- insurer-arranged Independent Medical Examinations (IMEs)
These opinions may conflict with your treating doctors, who know your condition best.
Surveillance or Activity Reports
Short video clips or isolated activities are often taken out of context and used to suggest you can work — even when they are consistent with your limitations.
Surveillance in long-term disability claims does not automatically justify a denial.
The Two-Year “Any Occupation” Change
Many policies change after 24 months from own occupation to any occupation.
Should You Appeal a Long-Term Disability Denial?
Internal Appeals (With the Insurance Company)
Most insurers encourage internal appeals — but they often fail.
Common problems include:
- the insurer reviews its own decision
- there is no neutral decision-maker
- appeals can delay cases until lawsuit deadlines expire
- claimants are asked to do the insurer’s work for them
Internal appeals should not be pursued without legal advice.
Legal Claims (External Challenges)
Legal action:
- moves the dispute to a neutral process
- preserves limitation periods
- forces insurers to justify their decisions
- often leads to settlement without trial
How Long Do You Have to Challenge an LTD Denial?
In most provinces, you have two years from the date of denial to start a legal claim.
If you miss this deadline:
- your claim may be permanently barred
- the insurer may never have to pay benefits
LTD Denials After Short-Term Disability
It’s common for insurers to approve short-term disability (STD), then deny LTD because:
- a different adjuster reviews the file
- the definition of disability becomes stricter
- updated medical reports are missing
- pre-existing condition exclusions are raised
LTD Denials After Short-Term Disability
It’s common for insurers to approve short-term disability (STD), then deny LTD because:
- a different adjuster reviews the file
- the definition of disability becomes stricter
- updated medical reports are missing
- pre-existing condition exclusions are raised
Conditions Commonly Affected by LTD Denials
LTD claims are frequently denied for conditions such as:
- chronic pain
- mental health conditions
- fibromyalgia
- migraine
- concussions and brain injuries
- fatigue-related illnesses
- long COVID
Many disabling conditions don’t show up clearly on scans — that does not disqualify you.
How a Long-Term Disability Lawyer Can Help
A long-term disability lawyer can:
- take over all communication with the insurer
- gather and organize medical evidence
- challenge flawed IME reports
- respond to surveillance allegations
- protect limitation periods
- negotiate a fair settlement
You focus on your health.
Your lawyer handles the insurer.
Speak to a Long-Term Disability Lawyer in Canada
If your long-term disability claim was denied or cut off, getting clear advice early can make a real difference.
At Samfiru Tumarkin LLP, we have helped tens of thousands of Canadians challenge LTD denials and recover compensation.
- ✅ No upfront fees
- ✅ No obligation to proceed
- ✅ Clear, practical guidance