at
If you rely on Desjardins for long‑term disability (LTD) benefits, a denial or interruption can be overwhelming. You are already dealing with serious health challenges, reduced income, and uncertainty about your future. Desjardins is one of Canada’s major disability insurers, and while many claims are approved, denials and terminations are common—especially at key transition points in the claim.
This guide explains why Desjardins denies LTD claims, how payment timing works, what to do after a denial, how to appeal, and when to involve a lawyer to protect your rights.
Desjardins denies disability benefits for a variety of reasons, many of which follow predictable patterns seen across the insurance industry. Understanding these reasons will help you prepare the evidence in a stronger way and anticipate the insurer’s arguments.
Desjardins may claim that your medical records do not provide enough detail or objective findings. Insurers expect clear documentation of functional limitations—not just a diagnosis, and a simple doctor’s note is often not enough on its own. Persuasive disability insurance claims usually include a detailed description of symptoms and restrictions from treating providers. Brief or inconsistent doctor’s notes can weaken your claim. Treating physicians should connect functional limitations to specific job duties. For a mental health claim, you could include a brief letter form from your therapist setting out the dates of treatment and the symptoms which make you unable to perform your occupation.
Desjardins frequently relies on internal medical consultants who never meet you but review your file and provide opinions. These consultants may conclude that you can work, even where your doctor says you remain limited.
During the first 24 months of LTD benefits, Desjardins evaluates whether your inability to perform the duties of your own occupation is supported by the medical and vocational evidence, including your employer’s description of your role or duties. If the insurer believes you can return to your job—even with significant restrictions—it may deny or terminate benefits. For this reason, it’s important to determine whether your employer provided an accurate description of your job duties.
After 24 months, Desjardins applies the stricter any occupation test. The insurer may argue that you can perform alternative work, even if it is unrealistic given your limitations, education, or experience. Your policy may provide an income level known as the “commensurate income” or “subsequent assessment” income. To satisfy the definition of disability in the any occupation period, you must prove that you cannot work at any occupation which would earn you that income.
Missed appointments, inconsistent treatment, and sparse medical notes can raise concerns. Desjardins may interpret gaps as evidence that your condition is improving or not severe.
Desjardins may use surveillance footage or social media posts to question your limitations. Short clips can be taken out of context and misinterpreted as proof that you are not as unwell and limited as you have told the insurer. It is best to limit your social media presence while you are claiming disability benefits. A social media post or a brief period of video surveillance is simply a brief snapshot of your life and it does not disprove your illness. Indeed, you may have received advice to be more active and to try to participate in the very activities that you have been observed performing.
Desjardins may cite exclusions for pre‑existing conditions, earning income from part-time work without disclosing it to the insurer, or non‑compliance with treatment. These issues often require careful review of the policy wording. Request a copy of the policy. Desjardins may refuse to provide you with a copy of the policy. It is your right to obtain the policy – insist on it.
Understanding how and when Desjardins pays LTD benefits helps you anticipate issues and identify potential red flags.
Desjardins typically pays LTD benefits monthly, often on a set date at the end of the month. Payments continue as long as you meet the policy’s definition of disability and comply with treatment requirements.
Most LTD policies include a waiting period—often 90 to 180 days—before benefits begin. During this time, you may receive short‑term disability (STD) benefits or rely on sick leave.
Many disability claims are terminated at the 24‑month mark, when Desjardins reassesses your claim under the stricter “any occupation” definition. You can challenge this decision by requesting information about the income Desjardins thinks you can earn and whether they have up to date medical information about your symptoms and treatment.
Desjardins may request updated medical records, forms, or assessments as part of the ongoing claim process. Delays in providing requested updates can lead to payment interruptions.
If your claim is approved after a delay, Desjardins may issue retroactive payments. Request a detailed statement and calculation in order to ensure that you have paid the appropriate amount.
A denial letter from Desjardins is not the end of your claim. You have options—but timing is critical. Here are the steps to take immediately.
The denial letter explains why Desjardins refused your claim and outlines your appeal rights. It also triggers strict legal deadlines.
You have the right to obtain all claim documents, including your entire claim file and internal records relevant to the review, such as:
This file is essential for understanding how Desjardins evaluated your claim.
Desjardins will rely on the insurance policy wording when it denies your claim. In order to properly respond to the denial, you need to have the actual policy wording. Desjardins may refer you to your employer to get a copy of the policy. Insist on getting the policy from the insurer – it is your right:
Section 293(5)(b) of the Insurance Act, RSO 1990, c I.8, provides:
Copy of application, policy, etc. — group insurance
(5) In the case of a contract of group insurance, an insurer,
(b) on request and reasonable notice, shall permit a group person insured or claimant under the contract to examine, and shall furnish to that person, a copy of the policy of group insurance. 2012, c. 8, Sched. 23, s. 36
Your doctor and other treating providers may need to provide updated medical evidence, clarify functional limitations, and expand on a doctor’s note with more detailed support if the claim involves chronic pain or similar hard-to-measure symptoms. Many denials occur because medical records lack detail.
Keep a daily log of your symptoms, restrictions, and challenges. This can support your appeal or lawsuit.
Consult a long term disability lawyer early to determine whether to appeal internally or proceed directly to litigation. Internal appeals do not pause legal deadlines, and many firms offer free consultations to help you assess next steps without upfront cost, while some also provide free consultations for initial guidance.
Desjardins typically allows internal appeals, but these appeals are often unsuccessful because they rely on the same insurer who made the initial decision. A strong appeal requires strategic preparation.
Your appeal should include:
Your appeal must respond directly to the issues raised in the denial letter. If Desjardins claims you can perform your job, provide occupational evidence showing why you cannot.
Special reports and letters from your treatment providers outlining the dates and type of treatment can strengthen your appeal.
In some cases, internal appeals are not worthwhile. If the denial is clearly flawed or if there is no new medical information to provide, moving directly to litigation may be the better strategy. Before skipping an internal appeal, confirm whether you are required to appeal before starting litigation.
Hiring a lawyer early in the process can significantly improve your chances of success after a denial. A disability lawyer can:
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.
You relied on Canada Life as your disability carrier to support you by paying your disability claim – a denial can feel devastating. […]
Manulife Long Term Disability Claims in Ontario Manulife long term disability insurance policies typically replace 60 to 70 percent of your pre-disability income […]
A Sun Life long-term disability denial is not the end of your claim. If your Sun Life long term disability claim was denied, […]
Reviews
