If your long-term disability claim was denied or your benefits were cut off, you should challenge the insurance company’s decision.
However, that doesn’t mean you should automatically follow the internal appeal process described in the insurer’s denial letter.
An internal LTD appeal asks the same insurance company that denied your claim to reconsider its own decision. In our experience, these appeals often produce another denial and delay stronger legal action.
For many people, the most effective way to challenge an LTD denial is to start a legal claim against the insurer rather than continue appealing internally.
A disability lawyer at Samfiru Tumarkin LLP can review your denial letter, insurance policy and claim file during a free consultation.
What Is a Long-Term Disability Appeal?
A long-term disability appeal challenges an insurance company’s decision to deny your claim or terminate benefits that were already being paid.
There are two main ways to challenge an LTD denial:
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An internal appeal: The insurance company reviews its own decision again.
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A legal claim: The dispute moves outside the insurer’s internal process and into the legal system.
Insurers often use the word “appeal” to refer only to their internal process. That isn’t your only option.
For a broader explanation of why claims are rejected, read our guide to what happens when long-term disability benefits are denied.
Should You Appeal a Long-Term Disability Denial?
Yes. You should challenge an LTD denial or cutoff.
The more important question is whether you should submit an internal appeal to the insurance company or start a legal claim.
Don’t assume that the appeal instructions in your denial letter identify the best option. Those instructions describe the process preferred by the insurer—not necessarily the process that best protects you.
Internal LTD Appeals
An internal appeal keeps the claim entirely within the insurance company.
The insurer controls:
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The appeal process
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The documents it asks you to provide
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The doctors and consultants who review the evidence
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The amount of time it takes to issue another decision
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The final outcome of the internal review
An internal appeal can occasionally correct a denial caused by a missing document or obvious factual error. However, you should still get legal advice before submitting it.
Legal Claims Against the Insurer
A legal claim moves the dispute outside the insurer’s private appeal process.
It allows your lawyer to:
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Demand the payment of past and ongoing disability benefits
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Obtain documents from the insurer
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Challenge insurer medical and vocational opinions
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Respond to surveillance and independent medical examination evidence
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Negotiate directly with the insurer’s legal representatives
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Pursue a settlement or court decision
Nearly all LTD legal claims resolve through negotiation or settlement before a trial is required.
Why Are Internal LTD Appeals Often Unsuccessful?
An internal LTD appeal isn’t reviewed by an independent decision-maker.
The same insurance company that denied or terminated your benefits decides whether its original decision should be reversed.
Common problems with internal appeals include:
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The insurer repeats the same reasons for denying the claim
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Additional medical evidence is discounted or ignored
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The insurer relies on its own medical consultants over your treating doctors
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More documents are requested without changing the insurer’s position
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The process takes months while legal deadlines continue to approach
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Statements made during the appeal are later used against the claimant
Submitting stronger evidence is important, but evidence alone doesn’t make the insurer a neutral decision-maker.
What Should You Do After an LTD Denial?
1. Get the Denial in Writing
The denial or termination letter should explain why the insurer says you don’t qualify for benefits.
Save the letter and every document that came with it.
2. Don’t Automatically Submit an Appeal
The insurer may give you 30, 60 or 90 days to appeal internally. Don’t mistake that deadline for your only option.
Get advice before sending additional information or committing to another insurer review.
3. Get Your LTD Policy and Claim File
Your policy identifies the definition of disability, exclusions, benefit period and other terms that govern the claim.
The insurer’s file shows how the decision was made and what evidence was used against you.
Read our guide on how to obtain your LTD policy and disability claim file.
4. Continue Medical Treatment
Continue attending appointments and following reasonable treatment recommendations.
Gaps in treatment give the insurer another argument for maintaining its denial.
5. Confirm Your Legal Deadline
The deadline to start a legal claim depends on the province, the wording of the policy, the denial letter and the history of the claim.
Confirm the deadline early. Don’t wait until the insurer finishes another internal appeal.
6. Speak With a Disability Lawyer
A lawyer can determine the strongest way to challenge the denial and protect your legal position.
How Does an Internal LTD Appeal Work?
An internal appeal generally follows these steps:
Step 1: The Insurer Denies or Terminates Benefits
You receive a written decision explaining why your claim was denied or why approved benefits are ending.
Step 2: You Submit More Evidence
This often includes medical reports, specialist records, occupational information and responses to the insurer’s arguments.
Step 3: The Insurer Reviews Its Own Decision
The insurance company can use its own adjusters, medical consultants and vocational specialists to reconsider the claim.
Step 4: The Insurer Issues Another Decision
The insurer approves the claim, requests further information or denies the appeal.
You don’t have to complete this process before starting a legal claim unless a specific legal requirement applies to your situation.
What Happens if Your Internal LTD Appeal Is Denied?
Another denial doesn’t end your claim.
The insurer may offer a second or third internal appeal, but you don’t have to continue repeating the same process.
Provided the applicable legal deadline has not passed, you can start a legal claim against the insurer.
A legal claim moves the dispute outside the insurer’s internal system and allows your lawyer to challenge the denial directly.
How Can a Long-Term Disability Lawyer Challenge a Denial?
A long-term disability lawyer reviews the denial, evidence and policy and determines the strongest way to challenge the insurance company.
A lawyer can:
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Confirm the legal deadline
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Review the denial letter and LTD policy
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Obtain the insurer’s claim file
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Identify weaknesses in the insurer’s reasoning
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Review IME, surveillance and vocational evidence
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Work with your doctors to clarify restrictions and limitations
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Prepare an internal appeal when that process is appropriate
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Start a legal claim against the insurer
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Negotiate the payment of past and future benefits
Getting advice early protects your options and prevents the insurer’s appeal process from controlling the direction of your claim.
Frequently Asked Questions About LTD Appeals
Should I Appeal a Long-Term Disability Denial?
Yes. You should challenge an LTD denial or cutoff. However, you shouldn’t automatically use the insurer’s internal appeal process. A legal claim may provide a stronger path.
Do I Have to Complete the Insurance Company’s Appeal Process?
Not necessarily. You don’t usually have to complete every internal appeal before starting a legal claim. Get advice based on your policy, province and deadlines.
Are Internal LTD Appeals Successful?
Internal appeals can succeed when a denial resulted from missing information or a clear factual error. However, the insurer remains the decision-maker and often maintains its original position.
What Is an External LTD Appeal?
An external appeal generally refers to starting a legal claim against the insurance company rather than asking it to reconsider the denial internally.
Can I Start a Legal Claim Without Appealing Internally?
In many cases, yes. The correct approach depends on your LTD policy, the applicable law and the history of the claim.
Does an Internal Appeal Stop the Legal Limitation Period?
Not necessarily. Never assume that an internal appeal pauses the legal deadline to start a claim.
How Many Times Should I Appeal an LTD Denial?
You don’t have to complete every appeal offered by the insurer. Repeated internal appeals often delay a legal claim without changing the insurer’s position.
Can I Challenge Benefits That Were Approved and Later Cut Off?
Yes. You can challenge both an initial LTD denial and the termination of benefits that were previously being paid.
Challenge Your Long-Term Disability Denial
An LTD denial can create serious financial and emotional stress, but the insurance company’s decision doesn’t end your claim.
Samfiru Tumarkin LLP represents people with denied and terminated long-term disability claims throughout Canada, excluding Quebec.
A disability lawyer can review your denial letter, policy, medical evidence and legal deadlines and explain the strongest way to challenge the decision.
Contact us for a free consultation before submitting an internal LTD appeal or allowing an important deadline to pass.