If your long-term disability (LTD) claim has been denied in Canada, you’re not alone — and it’s not the end of the road. Many people are wrongly denied benefits every year, even when their doctors confirm they can’t work.
Insurance companies often make mistakes, overlook medical evidence, or rely on opinions from assessors who barely met you. The good news: most LTD denials can be successfully challenged, and many clients receive a fair settlement once they get legal help.
This guide explains why insurance companies deny LTD, what to do next, and how to protect your rights under Canadian law.
What to Do Immediately After Your LTD Claim Is Denied
1. Read the denial letter carefully.
Look for the insurer’s reasons, dates, medical evidence they relied on, and any appeal deadlines.
2. Book an appointment with your doctor.
Share the denial letter with them and ask whether they disagree with the insurer’s conclusions.
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. Avoid internal appeals unless you’ve received legal advice.
Internal appeals rarely work and often delay claims until the two-year lawsuit limitation expires.
5. Speak to a long-term disability lawyer as soon as possible.
A lawyer can quickly assess whether the denial is justified and explain your options.
Why Long-Term Disability Claims Get Denied in Canada
Insurance companies deny claims for many reasons — some legitimate, others not.
The most common reasons include:
1. The insurer says you’re not “totally disabled”
This is the most common reason for denial. “Totally disabled” does not mean you must be bedridden.
→ Learn more: Total Disability Definition in Canada
2. Not enough medical documentation
Insurers often demand extensive notes, consistent treatment, specialist support, and clear functional limitations.
3. The insurance company disagrees with your doctor
They may rely on their own medical consultant or an IME.
→ Learn more: Independent Medical Examinations (IME) and LTD
4. The insurer thinks you can do a different job
This is common after the two-year “change of definition.”
→ Learn more: Change of Definition LTD in Canada
5. Surveillance footage
Short video clips can be misinterpreted or taken out of context.
→ Learn more: Surveillance and Long-Term Disability
6. A pre-existing condition clause
Insurers sometimes apply these incorrectly.
7. Missed paperwork or deadlines
Sometimes the problem is administrative, not medical.
🔎 For a deeper breakdown, visit our full guide: Common Reasons for LTD Denial (FAQ).
Should You Appeal the Denial? (Internal vs. External Appeals)
Internal Appeals (with the insurance company)
Insurance companies often encourage you to appeal directly to them. But internal appeals have major drawbacks:
- rarely successful
- handled by the same insurer who denied you
- not decided by a neutral decision-maker
- delays can push you closer to the two-year lawsuit deadline
- often require you to gather extensive new medical evidence
Unless a lawyer advises otherwise, internal appeals are not recommended.
External Appeal (legal claim)
This is the process of filing a legal claim against the insurer for denying your benefits. It is:
- handled by a neutral court system
- more effective and faster than internal appeals
- much more likely to result in a settlement
✅ 99.9% of cases settle out of court, meaning clients are paid without going to trial.
Learn more: Appeals and Long-Term Disability Claims
How a Long-Term Disability Lawyer Helps After a Denial
A lawyer 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 You’re Denied LTD After Being on Short-Term Disability?
This is extremely common. The insurer may approve STD but reject LTD due to:
- lack of updated medical evidence
- change of definition
- pre-existing condition exclusions
- a different claim examiner for LTD
Helpful resources:
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.
Can You Be Forced to Return to Work After a Denial?
Insurers sometimes push people to return to work too soon — even when unsafe.
- Learn more: Return to Work and Long-Term Disability FAQ
Does Surveillance Affect Your Case?
Surveillance is common, but it’s often misleading. Short clips rarely capture:
- pain levels
- fatigue
- cognitive issues
- recovery time after small tasks
📷 Real Client Case: Discover how Samfiru Tumarkin LLP used an insurance company’s surveillance report to win compensation for our client → Julie Austin vs. OTIP
Speak to a Long-Term Disability Lawyer in Canada
If your long-term disability claim has been denied, it’s important to get clear, reliable advice as soon as possible. These cases can feel overwhelming, especially when you’re already dealing with a medical condition, financial pressure, or uncertainty about your job.
Talking to a disability lawyer early on can help you understand:
- Why your claim was denied
- What evidence the insurance company is looking for
- Whether an internal appeal makes sense
- How the two-year limitation period applies to your case
- What steps you can take right now to strengthen your claim
Many people are surprised by how often LTD denials are reversed once the right medical information and legal arguments are presented.
At Samfiru Tumarkin LLP, our team has supported tens of thousands of Canadians through LTD denials and disputes. If you’re unsure what to do next, we can review your denial letter, answer your questions, and explain your options in straightforward language.
There’s no obligation to proceed — the goal is to give you clarity and direction.
✅ Professional Insight: Sivan Tumarkin, who leads our disability law practice, brings decades of experience working with disability insurance issues in Canada. His background allows our team to understand how insurers operate and how to respond effectively when a claim is denied.
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.