Applying for long term disability benefits is a difficult decision and the insurance claims process can be overwhelming. Disability benefits are a lifeline—providing financial support when illness or injury prevents you from working. If your insurance company denies or terminates your claim, you may be tempted to give up. This post examines the most common reasons for denied disability claims.

In this blog post, we’ll explore five major reasons disability claims are denied or terminated, explain how insurers justify their decisions, and outline some arguments you can use to challenge the insurance company’s decision.

1. Insufficient Medical Information

One of the most common reasons for denial is a lack of medical documentation. Insurance companies examine medical records to determine whether a claimant meets the definition of “disabled” under the policy. If your file doesn’t contain detailed, consistent, and up-to-date evidence, the insurer may argue that your condition isn’t severe enough to prevent you from working.

What is the Insurer’s View of Your Medical Evidence

• Your doctor may provide very brief notes without explaining functional limitations.
• Medical records may not include diagnostic tests, specialist reports, or what treatment has been attempted.
• Claimants sometimes miss appointments or do follow prescribed treatments, weakening their case.
• The insurance company may require you to attend for an independent medical examination with a medical provider of their choosing.

How to Protect Yourself

• Request detailed reports from your healthcare providers that outline your diagnosis, and how it impacts your ability to perform your job.
• Keep records current by seeing your doctor when required and updating the insurer regularly.
• Document your symptoms on a calendar or in a journal.
• Review your records and correct any errors about treatment and your doctor’s advice.
• Consider whether to appeal the insurance company’s decision if you have new information or can correct errors that are clear in the denial letter.

Without strong medical evidence, the insurance company’s decision will default to denial—even when when you are totally disabled.

2. Failure to Meet Policy Definitions of Disability

Disability insurance policies set out a contractual definition of disability. The definition usually changes after the initial period of disability. For example, many long term disability (LTD) policies apply the following tests:

• First 24 months: You must prove you cannot perform the essential duties of your own occupation.
• After 24 months: The definition shifts to whether you can perform another occupation which means any occupation reasonably suited to your education, training, or experience.

What Can Happen at Definition Change

Even if you cannot return to your previous job, your disability insurance provider may argue that you can perform another type of work, such as a sedentary role if you had a physical job at the time of your disability. Definition change is one of the most times that claims are terminated.

Preparing for the Definition Change Assessment

• Read your policy language thoroughly. Know when definitions change and prepare accordingly.
• Hire an experienced long term disability lawyer to provide vocational information to demonstrate that your condition prevents you from performing any suitable occupation.
• Challenge unfair assumptions— many LTD claims are denied at definition change because the insurer believes that your job is particularly difficult or stressful and that your medication condition only prevents you from performing your own occupation.

Many claims for disability insurance benefits end at definition change. It is important to understand that the insurer may have insufficient medical documentation about your continuing symptoms or incomplete information about your education, training and experience. These are good reasons to fight a disability claim denial.

3. Missing Filing Deadlines and Incomplete Forms/Applications

Your insurance policy will set out strict deadlines for filing claims and submitting medical updates. Missing these deadlines—even by a few days—can result in termination or a denied disability claim. Similarly, incomplete or inaccurate paperwork can result in a denied claim.

Common Pitfalls

• Claimants delay applying for benefits because they hope to recover quickly.
• Forms are submitted without being signed or containing all parts of the application form.
• Your doctor may be too busy or be on leave at the time that an updated is requested.

How to Protect Yourself

• Keep track of deadlines on a calendar and ask a family member or friend to help you to ensure you meet them.
• Double-check paperwork and make sure you have all parts of the disability claim form when you apply.
• Consider hiring a disability lawyer early to ensure your application reads well and is complete.
• Check with your doctor if the insurer says that they have requested an update.

Insurers deny disability claims where the forms are incomplete and will terminate benefit claims if they do not have updated information regarding your medical conditions and treatment. Stay on top of the information requested by your insurance company and follow up to make sure that they have received everything.

4. Surveillance

In some cases, insurance companies will hire private investigators to conduct surveillance. If they film you performing activities that appear inconsistent with the symptoms and limitations you have reported, they will terminate your insurance claim.

Examples

• A claimant with chronic back pain is filmed carrying heavy items such as groceries.
• Someone with depression is seen socializing at a party or exercising in public.

While these activities do not prove you can work full-time, your insurance company may conclude that you exaggerating your condition.

What Can You Do

• Don’t exaggerate when you describe your limitations to doctors, insurers, and in daily life.
• Explain context —lifting a light bag once doesn’t mean you can work eight hours a day.
• Challenge surveillance evidence with medical testimony explaining why isolated activities don’t equate to employability.

Surveillance evidence is simply a snapshot of what you can do but it can be used to justify termination of your LTD claim.

5. Changes in Eligibility or Policy Interpretation

Even after your disability claim is approved, it can be terminated later based on policy requirements or a reassessment of your entitlement. This often occurs at the two-year mark when the definition of disability changes, but it can also happen if you insurance company believes that:

• Your condition has improved.
• You have refused or failed to comply with treatment recommendations.
• You are capable of performing modified work or a different position.
• Your insurer may claim that your medical condition is not payable because it is a pre-existing condition and is excluded under the policy.

How to Protect Yourself

• Stay proactive—continue submitting medical updates when requested.
• Follow the advice of your doctor and document reasons that you cannot afford certain treatment (e.g. physiotherapy if you have not extended health benefits) or take medication (e.g. if you have an adverse reaction).
• Seek the advice of an experienced disability lawyer if your insurer applies disability insurance policy’s terms unfairly.

Insurers have a duty to fairly assess your long term disability claim but if they conclude that they can deny or terminate those claims, they will do so.

Practical Strategies for Claimants

The following tips will help you avoid having your disability claim denied:

• Build a strong medical team: Specialists, therapists, and family doctors can provide comprehensive evidence.
• Keep your communication polite and professional: Respond respectfully and clearly to insurer requests.
• Document everything: It is important to keep track of your symptoms, treatment and new developments and keep the insurer informed on an ongoing basis.
• Seek legal representation: Disability lawyers understand insurer tactics and can advocate effectively.
• If your disability claim is denied for a highly technical reason such as the results of an independent medical examination, a policy exclusion such as pre-existing condition or not following an appropriate treatment plan or missing a deadline, do not attempt to the appeals process without the advice of an experienced disability lawyer.

Conclusion

Disability claims are denied or terminated for a variety of reasons, but the most common involve insufficient medical evidence, failure to meet policy definitions, missed deadlines, surveillance, and changes in eligibility. By understanding these pitfalls and preparing accordingly, claimants can significantly improve their chances of success.

Insurance companies often rely on technicalities and strict interpretations of policy language. Claimants who remain proactive, organized, and supported by medical and legal professionals stand the best chance of securing the benefits they need.

Your long term disability benefits are too valuable to give up if the insurance company denies your claim. Schedule a free consultation with one of the experienced disability lawyers at Burn Tucker Lachaîne P.C. to discuss your case.

For advice please text 613-777-0992 or contact us through our website to schedule a meeting with one of our lawyers.  We provide a free consultation, in French or English, to ensure that your rights are protected.   In most cases, we can offer to represent you on a contingency fee basis.  This means that you do not pay legal fees unless you win or achieve a settlement on your case.