If your long-term disability claim was denied, your insurance company may tell you that the next step is to file an appeal.
Many disability policies include an internal appeal process where the insurer reviews its own decision. While appeals may sometimes help clarify missing information, they are not always the best strategy for challenging an LTD denial.
Understanding how long-term disability appeals work in Canada can help you decide what to do next.
This guide explains:
- What a long-term disability appeal is
- How the internal appeal process works
- Why many appeals fail
- When an appeal may make sense
- How legal action can challenge a disability denial
What Is a Long-Term Disability Appeal?
A long-term disability appeal is a request for the insurance company to reconsider its decision after denying or terminating your benefits.
Most appeals happen within the insurer’s internal review process.
This means:
- The same insurance company reviews the decision
- Additional medical information may be submitted
- The insurer decides whether to reverse the denial
Appeals usually involve submitting additional documentation, such as:
- Updated medical records
- Reports from treating physicians
- Functional capacity information
- Clarification of job duties
How the LTD Appeal Process Works
The long-term disability appeal process varies slightly depending on the insurance policy, but it usually follows these steps.
Step 1: Denial Letter
The insurer sends a letter explaining why your disability claim was denied or your benefits were terminated.
This letter often outlines:
- The insurer’s reasoning
- Medical evidence relied upon
- Deadlines for submitting an appeal
Step 2: Submitting an Appeal
To appeal the decision, the claimant may submit additional information such as:
- Updated medical documentation
- Specialist reports
- Clarification from treating doctors
- Additional employment information
The insurer then re-examines the claim.
Step 3: Internal Review
The insurance company reviews the file again.
This review may involve:
- Internal medical consultants
- Paper file reviews
- Additional insurer-arranged independent medical examinations (IMEs)
After reviewing the information, the insurer decides whether to:
- Approve benefits
- Maintain the denial
Why Many Long-Term Disability Appeals Fail
While insurers encourage appeals, internal appeals often do not change the outcome.
Insurers sometimes rely on surveillance in long-term disability claims or activity reports to argue that a claimant can work.
Common reasons include:
The Insurer Reviews Its Own Decision
Internal appeals are typically handled by the same insurance company that denied the claim.
This means the decision is not reviewed by a neutral party.
The Appeal Focuses on the Same Evidence
If the appeal simply repeats information already provided, the insurer may reach the same conclusion.
Without stronger medical evidence or legal arguments, the outcome may not change
Appeals Can Delay Legal Action
Appealing a denial can take months.
In the meantime, legal deadlines may continue to run.
When Appealing a Disability Denial May Make Sense
In some cases, a long-term disability appeal may be appropriate.
For example:
- Important medical records were missing from the original application
- The insurer misunderstood a medical report
- A specialist evaluation was pending at the time of denial
- The denial was based on a clearly fixable issue
In these situations, submitting additional information may help resolve the problem.
Legal Claims vs Internal Disability Appeals
Instead of appealing internally, some claimants choose to challenge the denial through a legal claim against the insurer.
Legal action moves the dispute outside the insurance company and into a neutral process.
This approach can:
- Preserve legal deadlines
- Require insurers to justify their decisions
- Create opportunities for settlement
- Shift the dispute into a more balanced process
Every situation is different, and the best approach depends on the specific circumstances of the claim.
How a Long-Term Disability Lawyer Can Help With an Appeal
A disability lawyer can review your denial and help determine whether an appeal or legal action is the better strategy.
This may involve:
- Reviewing the insurance policy
- Analyzing the insurer’s reasoning
- Assessing medical evidence
- Identifying gaps in the claim file
- Advising on deadlines and legal options
Speak to a Long-Term Disability Lawyer About an Appeal
If your long-term disability claim was denied or your benefits were terminated, you may have options.
At Samfiru Tumarkin LLP, our disability lawyers help Canadians understand their rights and challenge unfair LTD denials.
- ✅No upfront fees
- ✅No obligation to proceed
- ✅Clear advice on appeals and legal options