In part 1 of this article, we explain the long term disability appeal process. When writing an appeal letter, it’s helpful to have a step by step guide and an example of an effective appeal letter. Many LTD lawyers will only open a file after you have exhausted any appeal you wish to submit. Your Appeal Letter – A Step by Step Guide

What follows is “how to” guide so that you can prepare your appeal letter without a lawyer’s help.

Step 1: Review the Denial Letter

Your denial letter is the roadmap for your appeal. It tells you:

• Why the insurer denied your claim
• What evidence they relied on
• What evidence they claim is missing
• What deadlines apply
• What appeal steps are required under your policy

Read the letter carefully. Look for:

• Misstatements of your medical condition
• Incorrect assumptions about your job duties
• Reliance on “paper reviews” by doctors who never examined you
• Claims that your medical evidence is “insufficient” without explaining why
• References to surveillance, social media, or return‑to‑work expectations

Find and use supporting evidence to address any lack of details or documentation cited in the denial. Review your denial letter carefully to understand the reasons behind the decision. Note any specific questions or requests for further information from the insurer. Collect detailed doctors’ notes to clarify your symptoms and limitations.

Every issue raised in the denial letter should be addressed in your appeal.

Step 2: Request the LTD Claim File

The denial letter will provide the reasons for denial of your initial claim. Not every denial letter provides sufficient detail to determine what additional medical records or other information is necessary. It is always a good idea to request the following:

• A copy of the complete, unredacted claim file
• The insurance policy – if the insurer directs you to request a copy of the policy from your employer, remind them that the Ontario Insurance Act  requires them to provide the policy to you.
• If you received benefits for a period of time, you should request a statement of all benefits paid to date
• The benefit details including the definition of disability, the elimination period and the benefit amount

When you receive the claim file, review it to see if anything is missing. For instance, if the denial letter references an internal medical review or a medical consultant opinion, make sure that this opinion is included with the claim file.

Step 3: Gather Supporting Documentation

Gathering supporting documentation is an essential part of the long term disability appeal process. Start by collecting detailed medical records, treatment reports, and up-to-date statements from your treating physician. These documents should clearly outline your diagnosis, the progression of your condition, and how it affects your ability to work. It’s important to include any new information that has become available since your initial application, such as recent test results, updated medical opinions, or additional specialist reports.

Make sure your supporting documents are relevant and directly related to your long term disability claim. Keep copies of all correspondence with your insurance company, including claim references and denial letters, as these may be needed for future reference. By providing comprehensive and detailed medical records, you strengthen your appeal and increase the likelihood of a favorable outcome.

Step 4: Write an Effective Appeal Letter

An effective LTD appeal letter should begin with a formal header that includes your contact details, a clear subject line summarizing the letter’s purpose, and end with a polite closing and your signature. Early in the letter, make a clear statement of purpose, formally requesting reconsideration of the decision.

A persuasive LTD appeal letter is clear, factual, and supported by evidence. It should:

• Identify the decision you are appealing
• Summarize your medical condition and how it prevents you from working, including a personal statement detailing how your condition affects your daily life
• Address each reason for denial with specific evidence
• Correct inaccuracies in the insurer’s report
• Reference supporting medical documentation
• Explain functional limitations, not just diagnoses
• Describe your job duties and why you cannot perform them
• Maintain a professional, factual tone
• Meet the insurer’s criteria for disability as outlined in their policy and medical evaluation requirements
• Express gratitude for the recipient’s time and consideration
• Avoid emotional or accusatory language to maintain professionalism

Your goal is to show the insurer that the denial was based on incomplete or incorrect information and that the full evidence supports your disability. At the end of your letter, politely request consideration of the new information you have provided.

A Sample Appeal Letter

Below is a polished, professional long term disability appeal letter template you can can adapt to your situation. It is structured, evidence‑focused, and written in a tone which is clear, authoritative, and persuasive without unnecessary emotion.

Long Term Disability Appeal Letter Template

[Your Full Name]
[Your Address]
[City, Province, Postal Code]
[Phone Number]
[Email Address]

Date: [Insert Date]

Appeals Department
[Insurance Company Name]
[Insurance Company Address]

Subject: Formal Appeal Request – Long Term Disability Denial
Policy Number: [Insert Number]
Claim Reference Number: [Insert Number]

1. Statement of Appeal

I am writing to formally request reconsideration of the denial of my long term disability benefits dated [insert date of denial letter]. I believe I deserve benefits under the policy’s criteria, as my medical condition and limitations meet the requirements set forth by the insurance company. The purpose of this appeal is to clarify my eligibility for benefits and to address how my situation satisfies the specific criteria for disability outlined in the policy.

After reviewing the reasons provided, I believe the decision does not reflect the full medical evidence, the functional limitations caused by my condition, or the demands of my occupation. I am submitting additional documentation and clarification to support my appeal.

2. Summary of Medical Condition and Functional Limitations

I have been diagnosed with [primary diagnosis], along with [secondary conditions, if applicable]. My symptoms include

, which significantly limit my ability to perform essential work duties. My condition affects my daily life by making it difficult to complete routine tasks, maintain personal care, and participate in normal activities. As a result, I am considered disabled under the policy’s criteria. These limitations include:

• [Example: Reduced ability to sit, stand, or walk for extended periods]
• [Example: Cognitive impairments such as reduced concentration or memory]
• [Example: Pain, fatigue, or other symptoms that interfere with consistent work performance]

To clarify, any suggestion that I am able to work despite my condition does not accurately reflect my current abilities or the impact of my symptoms. Including detailed doctors’ notes and medical documentation is essential to support my appeal and provide clear evidence of my limitations.

My treating providers have consistently documented these limitations and have advised that I am unable to safely or reliably perform the duties of [your occupation].

3. Response to the Reasons for Denial

Your denial letter states the following reasons for the decision. I address each point below:

a. “Insufficient medical evidence”
I am submitting updated medical records, specialist reports, and diagnostic results that provide detailed clinical findings supporting my disability. These documents show the severity of my condition and directly address the lack of objective medical evidence cited in your denial. I would like to clarify any misunderstandings or errors in the interpretation of my previous records by providing clear explanations and factual details. It is important to use supporting evidence to strengthen my arguments and demonstrate why the decision should be reconsidered. These include

.

b. “Paper review suggests you can return to work”
The reviewing physician did not examine me in person. Their conclusions do not reflect the severity of my symptoms or the functional limitations documented by my treating providers, who have assessed me regularly and have firsthand knowledge of my condition.

c. “Job duties can be performed with restrictions”
My occupation requires [describe physical, cognitive, or psychological demands]. Due to my limitations, I cannot perform these duties safely, consistently, or at a competitive level. I have included a detailed job description and a functional assessment that explains why accommodations are not sufficient.

If the denial letter included additional reasons, each should be addressed in a similar factual, evidence‑based manner.

4. Supporting Evidence Included with This Appeal

I am submitting the following documents in support of my appeal:

• Updated clinical notes from [provider name]
• Specialist reports from [specialist name]
• Diagnostic imaging or test results dated [insert dates]
• Functional Capacity Evaluation (if applicable)
• Workplace documentation, including job description and accommodation attempts
• Any additional supporting statements from treating providers
• Enclosures: Additional supporting documents such as medical records, detailed doctors’ notes, and other relevant evidence

These documents provide a comprehensive and accurate picture of my medical condition and its impact on my ability to work. It is important to include detailed doctors’ notes, as they can clarify symptoms and link medical findings to work limitations. Providing comprehensive details in your supporting evidence strengthens your appeal and addresses any overlooked or misinterpreted factors affecting your claim.

5. Request for Reconsideration

Based on the complete medical evidence and the information provided, I respectfully request formal reconsideration of the decision to deny my claim and ask that you overturn the denial and approve my long term disability benefits. My condition continues to prevent me from performing the essential duties of my occupation, and the documentation submitted clearly supports my eligibility under the terms of the policy. I hope that, with the additional evidence and clear explanation provided, my appeal will have a greater chance of success.

Please confirm receipt of this appeal and advise if any further information is required.

Thank you for your consideration of the new information and for your attention to this matter.

Sincerely,
[Your Full Name]

After the Appeal Decision – What Now?

Unfortunately, many long term disability benefit appeals are unsuccessful. Some insurance companies do not have a separate appeal department or adjudicator. This means that the “appeal” is actually simply a reconsideration by the original decision-maker. If you have new information which the claims examiner did not see when your claim was submitted, your appeal may be successful. If your insurer has a separate appeal department, the new adjudicator may overturn the denial.

Your Appeal Is Successful – An Accepted LTD Claim

If your appeal is successful, congratulations and what a relief! You will have questions about what comes next. We encourage you to review these articles about LTD insurers and what happens when you are “on claim”:

1. What Can the Insurance Company Make Me Do When I Am On Claim?
2. How much will I receive for long term disability benefits?
3. Can You Travel While on Long Term Disability in Canada?
4. Why Apply for CPP Disability Benefits?

Your Appeal Is Denied – Seek Legal Help

The unfortunate truth is that most LTD appeals are denied. We understand how disheartening this is and that there has been delay waiting for the decision as well as the result of your appeal. Call us to book a free consultation with an experienced LTD lawyer.

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.