How Insurance Companies Handle Long Term Disability Claims
Filing for long term disability benefits is not a straightforward process. Even for eligible applicants with legitimate claims, disability insurance companies have specific criteria and procedures that must be met.
The insurance provider will examine your medical condition, your ability to work, and the policy details outlined in your coverage. While many claims are approved, others may face delays or denials—not necessarily due to lack of merit but due to how the insurer interprets the information provided.
LTD insurance carriers are bound by their contractual obligations, and they follow internal procedures and guidelines to assess eligibility. Their review process often includes evaluating whether you meet the definition of “totally disabled” under the terms of your policy.
This is why having accurate medical records and strong medical evidence is crucial. A knowledgeable and experienced disability lawyer can help you present your case clearly and thoroughly, increasing your chances of approval.
Dealing with a Denied Disability Claim? Here’s What Comes Next
Receiving a denied claim letter can feel like a punch to the gut, especially when your illness or injury prevents you from earning a living. But a denial isn’t the end of the road. Whether your claim was denied due to incomplete forms, missing medical evidence, or a disagreement about your total disability status, you still have legal options.
Navigating the appeal process can be daunting on your own. A lawyer with extensive experience in disability matters can help you understand your rights, request the insurer’s file, gather additional evidence, and submit a strong appeal. At this stage, time is critical. Missing deadlines can jeopardize your ability to challenge the decision, so seeking legal support quickly is vital.
Putting Your Best Interests First — Every Step of the Way
When your health and livelihood are on the line, you deserve a partner who puts your best interests first. At our firm, our Orangeville disability lawyers approach every case with empathy, dedication, and unwavering commitment. We understand the emotional and financial toll a denied LTD claim can cause, and we make it our mission to relieve some of that burden.
You won’t face the legal process alone. From the first call to the final resolution, we provide clear guidance, responsive communication, and strategic legal representation tailored to your unique circumstances. With no upfront fees and no cost unless we win, your focus can remain on your health and recovery.
Eligibility for Disability Benefits
To receive long term disability benefits, you must meet specific eligibility requirements set out by your policy. Most policies cover both physical and mental illness, but each one defines total disability differently. Some are based on the “own occupation” standard—where you must prove you cannot perform the duties of your specific job. Others shift to an “any occupation” standard after some time, requiring you to demonstrate that you cannot work in any reasonable job given your education, training, and experience.
Eligible applicants must also provide strong medical evidence that clearly links their condition to their inability to work. These details matter, and so does how they’re presented. Our legal team can help interpret your policy, assess your situation, and ensure your application is as compelling as possible.
LTD Benefits Application
The LTD claim process often begins while short term disability benefits are still being paid. Once it becomes clear that your condition will last beyond that timeframe, it’s time to file for LTD benefits. The application typically includes:
- Detailed medical records
- Physician statements
- Employer records
- Completed claim forms from both you and your doctor
This process can be time-consuming and detail-heavy. Any inconsistencies can delay or jeopardize your claim. We assist clients in Orangeville with every aspect of their applications to ensure nothing gets overlooked.
Common Reasons for Claim Denials
Disability insurance companies may deny claims for a variety of reasons, including:
- Insufficient or unclear medical evidence
- Failure to meet the policy’s definition of total disability
- Gaps or contradictions in your supporting medical files
- Missed deadlines or incomplete forms
- Surveillance suggesting you can perform work-related tasks
In some cases, denials are the result of clerical errors or miscommunications between your physician, your employer, and the benefits providers. In others, the denial may stem from a misunderstanding of your medical condition or a misinterpretation of policy details. Disability insurers rely heavily on documentation and timelines, and any omission or inconsistency—however minor—can jeopardize an otherwise valid claim.
It’s important to remember that a denied claim doesn’t necessarily reflect the strength of your case. If you believe your LTD payments were wrongfully denied, our legal services are here to help assess your options and guide you forward.
Appealing a Denied Long Term Disability Claim
An appeal can be your chance to correct, clarify, or strengthen your LTD claim. It requires more than just resubmitting the same information. Successful appeals are well-organized, evidence-rich, and legally sound.
Appealing a denial gives you the opportunity to tell your story more fully—backed by updated medical evidence, expert opinions, and a clearer legal narrative. We work closely with clients to identify what went wrong in the initial decision and build a more compelling case moving forward.
Our Orangeville disability lawyers will help you:
- Review your denial letter and insurer’s reasoning
- Gather additional medical evidence
- Consult medical and vocational experts if needed
- Draft persuasive appeal submissions based on disability law
We take pride in our track record of helping clients overturn denied claims and secure the disability benefits they deserve.
Deadlines for Filing an LTD Claim
Time limits vary depending on your policy and jurisdiction, but generally, you must:
- File your initial claim within a specific window after becoming disabled
- File an internal appeal within 60 to 90 days of receiving a denial
- File a lawsuit within a limitation period (often two years in Ontario)
Missing these deadlines can make your claim ineligible, regardless of merit. That’s why we encourage every client to schedule a free consultation as soon as possible.
How a Lawyer Applies Disability Law to Your Case
Disability law involves interpreting complex contracts, applying provincial legal standards, and understanding how courts and disability insurers evaluate claims. An experienced disability lawyer will:
- Analyze the fine print of your insurance policy
- Compare your case against legal precedents
- Ensure your medical evidence supports the legal definition of disability
- Protect your rights throughout the legal process
With clear guidance from our team, you’ll feel more empowered and prepared to navigate the road ahead.
Benefits of Hiring a Long Term Disability Lawyer
Handling a disability claim on your own is stressful and time-consuming, especially when your energy is already stretched thin due to illness or injury. Working with an LTD lawyer can offer peace of mind and increase your chances of success.
Here’s what you can expect from our legal support:
- We handle communication with the insurance companies
- We collect and organize all necessary documents
- We represent you in negotiations or court, if needed
- We ensure your rights are protected at every stage
Best of all? There are no upfront fees. You only pay if we obtain a settlement for you or win your case in court.
Book a Free Consultation With a Disability Lawyer in Orangeville
Choosing the right legal representation is a big decision—and it starts with a simple conversation. We offer a free consultation to help you better understand your options, your rights, and how we can help.
We’ve helped countless clients in Ontario, including those with claims against major insurers like Canada Life, Sun Life, Blue Cross and Manulife . Our client testimonials speak volumes about the quality of our service and the results we deliver.
If your injury or illness prevents you from working and you need help navigating your disability claim, contact us today. We’re proud to serve the Orangeville community and are ready to stand by your side every step of the way.
Contact us now to schedule your free consultation and get the legal support you’re entitled to.
April 25, 2025 
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