Being told that your long-term disability (LTD) claim has been denied can be devastating. Many people rely on disability benefits to pay for housing, food, and medical treatment. When an insurer denies a claim, it can create enormous stress and uncertainty.
If your long-term disability claim has been denied in Ontario, it is important to understand your legal rights and the options available to challenge the denial.
Why Do Insurance Companies Deny LTD Claims?
Insurance companies deny disability claims for many reasons. Some of the most common include:
- Insufficient medical evidence
Insurers often argue that medical records do not prove that you are unable to work. - Disputes about the definition of disability
Most policies define disability differently at different stages of the claim. - Surveillance or social media evidence
Insurance companies may claim that surveillance footage or social media posts contradict your disability claim. - Independent medical examinations (IMEs)
Insurers frequently send claimants to doctors who provide opinions favorable to the insurer.
In many cases, these denials are not justified and can be successfully challenged.
Should You Appeal the Insurance Company’s Decision?
Many disability policies include an internal appeal process. However, appealing directly to the insurer is not always the best option.
Internal appeals often involve:
- Submitting additional medical documentation
- Responding to the insurer’s reasons for denial
- Attending further medical assessments
While some claims are approved after an appeal, many are denied again.
Before starting an internal appeal, it is often wise to speak with a disability lawyer to understand the best strategy.
Starting a Lawsuit for Disability Benefits
If your claim is denied, you may have the right to start a lawsuit against the insurance company.
A lawsuit may allow you to recover:
- Unpaid disability benefits
- Future disability benefits
- Interest on overdue payments
- Legal costs
In many cases, lawsuits lead to negotiated settlements before trial.
What Evidence Helps a Disability Claim?
Strong disability cases often include:
- Detailed medical records
- Reports from treating physicians
- Specialist opinions
- Functional capacity evaluations
- Employment records
The stronger the medical evidence, the more difficult it is for an insurer to justify a denial.
When Should You Speak with a Disability Lawyer?
If your long-term disability claim has been denied, it is important to obtain legal advice as soon as possible.
A lawyer can help you:
- Review the insurance policy
- Evaluate the insurer’s reasons for denial
- Gather medical evidence
- Determine whether to appeal or start a lawsuit
As a disability benefits lawyer, I offer free consultations, allowing you to understand your options before taking further steps. Don’t hesitate to call me — let’s discuss your options.
Phone: 1-844-333-0905
