When you receive a denial of your long-term disability (LTD) claim, you face a choice: accept the insurer’s decision or challenge it. If you decide to appeal, you need to follow the insurer’s timeline and present persuasive evidence. Many people weaken their case because they make avoidable mistakes. This guide explains those mistakes and shows you how to avoid them.

Understanding the LTD Appeal Process in Ontario

Insurance companies will provide a denial letter which sets out the reason that your long term disability benefits have been denied. They will usually offer a right to appeal the decision, providing an appeal deadline for you to submit your request for reconsideration.

Some background on the long term disability benefits appeals process:

1. most LTD insurance policies do not outline an internal appeals process;
2. therefore, while the denial letter may appear to set out a strict deadline to submit an appeal, you may be able to persuade the insurance provider to extend the time for filing an appeal;
3. an internal appeal may involve the same claims adjudicator reconsidering their own decision – i.e. often there is no separate appeal team or new “set of eyes” reviewing the insurance company’s decision;
4. in some limited cases, you may be required to submit an appeal before taking legal action (for instance the Ontario Teachers Insurance Plan (OTIP) policy requires you to submit an appeal before suing the insurer;
5. in most cases, you are not required to use the insurance company’s internal appeal process and can proceed straight to litigation to challenge your denied LTD claim; and
6. there are some cases where no appeal is offered such as where the insurer says there is no coverage for your claim.

Common Mistakes When Appealing LTD Denials

1. Missed Deadlines

Insurers set firm deadlines for appeals. Some policies give you only 30 or 60 days. If you miss the deadline, you lose the right to appeal.

• Example: You receive a denial letter dated March 1. The policy requires you to appeal within 60 days. You should submit your request for reconsideration of the insurer’s decision by April 30.

Take these steps:

1. Record the deadline immediately;
2. Start preparing your appeal right away – speak with your doctor to see if they will write a letter of support and ask about their time constraints;
3. Advise the insurer of any problems you are facing in meeting their deadline and politely request an extension of the appeal deadline;
4. Make sure that all of your communication is in writing and confirm any extension you receive; and
5. Do not wait until the last week.

2. Insufficient or Incomplete Medical Evidence

You cannot rely on a short doctor’s note that says “unable to work.” Insurers expect detailed medical documentation setting out your symptoms and medical condition and the way those symptoms prevent you from performing your job.

• Example: You submit only a brief family doctor’s note. The insurer denies your appeal because the note does not explain how your condition prevents you from working.

What you should do:

1. Collect specialist reports, diagnostic tests, and ask your treating doctor to write a detailed description of your illness and symptoms;
2. Outline how your condition limits your ability to perform your job; and
3. Describe the specific duties and functions which you cannot perform due to your symptoms.

3. Ignoring the Policy Definition of Disability

Your policy defines disability in specific terms. Some policies have an “own occupation” disability test while others use “any occupation” either from the date of disability or after a set period. If your evidence does not match the definition, the insurer will deny your appeal.

• Example: You work as a mergers and acquisitions lawyer. You submit evidence that fatigue prevents you from working long hours. The insurer argues you can still perform general legal work because your evidence does not address the duties of your specific occupation.

What you should do:

1. Read your policy carefully;
2. Provide information about your occupation, its duties and requirements;
3. Outline both your subjective complaints and the objective findings which show that you are totally disabled as set out in the policy.

4. Write an Emotional Appeal Without Documentation

You may feel tempted to write a long letter describing your pain and frustration. Insurers do not base decisions on emotion. They rely on objective evidence.

• Example: You send a 10-page letter about your suffering. The insurer denies your appeal because you did not include medical or vocational evidence.

What you should do:

1. Combine your personal account with medical records and a detailed medical history.
2. Support your story with facts. If you are prevented from working because you are short of breath and become easily exhausted, describe your specific restrictions. For example, if you are unable to walk up a flight of stairs without needing to sit and rest, say that specifically.
3. Don’t exaggerate and be specific.
4. Do not insult the insurance company of suggest that they are biased, always deny claims or lack medical training. Be professional and respectful.

5. Accept the Insurer’s Medical Review Without Challenge

Insurers often use their own in house medical consultants. These consultants do not examine you or speak with you. They review your written file and form opinions about your condition which they provide to the insurance claim adjudicator.

• Example: The insurer’s consultant states that your depression appears “stable.” You do not challenge the opinion with medical opinion of your own doctor. The insurer denies your appeal.

What you should do:

1. Ask for a copy of your entire claim file and provide your treating doctor with a copy of the insurer’s internal medical review.
2. Obtain a letter of support from your own doctor which should outline flaws in the insurer’s review, such as factual errors or incomplete analysis.
3. Ask the insurer for the credentials of the inhouse medical reviewer. If your medical practitioner is a specialist and the insurer had a nurse or general practitioner review your mental health claim, you should point this out in your appeal.

6. Overlook Vocational Evidence

Disability claims involve both medical and occupational considerations. If you fail to show how your condition affects your job duties and the insurer does not understand your job demands, your long term disability claim will be denied.

• Example: You are a dentist with carpal tunnel syndrome. You submit medical records showing a diagnosis but no evidence about the restrictions caused by your medical condition or the demands of your daily work. The insurer denies your claim on the basis that there is insufficient medical evidence of disability.

What you should do:

1. Provide a detailed medical opinion which sets out the restrictions and limitations caused by your condition;
2. Set out a thorough description of your day and the physical demands which are impacted by your condition, outlining how your condition prevents you from performing your essential duties; and
3. Get advise from an experienced disability lawyer and consider obtaining an independent medical examination supporting your claim.

7. Participating in Multiple Appeals

Many people try to handle appeals alone because they want to avoid paying for a lawyer. They consult a lawyer only after repeated denials. If you wait too long and simply participate in the insurer’s internal appeal process, you may miss a limitation deadline while will result in you having no legal option to challenge the insurer’s decision.

• Example: Your claim is denied on April 1, 2023. You file three unsuccessful appeals before hiring a lawyer. The last appeal is denied by the insurance company on January 30, 2025. Hire a lawyer on June 30, 2025. The limitation period has expired and you cannot sue to enforce your long term disability insurance claim.

What you should do:

1. Consult a lawyer after you receive a denial.
2. Early advice helps you avoid spending valuable time appealing the insurer’s decision when you should be issuing a Statement of Claim in court.
3. Make sure that you keep track of any limitation period which is set out in your denial letter and understand that the insurer will rely on the limitation period even if it has considered an appeal over a period of many months.

Seek Legal Help from a Disability Lawyer to Appeal and Win Your Claim

When you appeal a denied LTD claim, you need to act quickly, understand the policy definition, and submit supportive evidence. Avoid mistakes such as missing deadlines, sending incomplete records, or sending an angry, emotional appeal.

You do not need to manage the appeal alone. An experienced disability lawyer can help by reviewing your policy, preparing the evidence, and challenging the insurer’s decision.

Contact us by text at 613-777-0992 or through our website to schedule a consultation. We provide free consultations in French or English. In most cases, we represent clients on a contingency fee basis, which means you do not pay legal fees unless you win or reach a settlement.