Getting denied long-term disability (LTD) benefits can feel like getting kicked when you’re already down. You’re not working, your health is at risk, and now the insurance company is saying, “Sorry, you’re not disabled enough.”
If you’re living in Ontario and have just discovered that your LTD claim has been denied, you’re not alone. This unfortunate situation affects thousands of people each year, many of whom legitimately cannot work. However, the good news is that denial is not the end of the road; it is quite the opposite.
At Bergel Magence Personal Injury Lawyers, we’ve helped countless Ontarians turn their denials into approvals or settlements. We understand how frustrating the process is and have fought on our client’s behalf to get the compensation they deserve. So, let’s walk through what you should do next and, more importantly, what not to do.
Why Are LTD Claims Denied in Ontario?
First things first: why was your claim denied?
Insurance companies are for-profit businesses that have a financial incentive to minimize payouts. And while not every adjuster is a villain, it’s common for insurers to use vague definitions and technicalities to deny valid claims.
Some of the most common reasons for denial include:
- Insufficient medical evidence – The insurer may claim that your doctor’s records don’t show sufficient proof that you cannot work.
- Surveillance – Yes, they might follow you, and if they see you doing “normal” activities, like carrying groceries or walking your dog, they might use this information against you.
- Missed deadlines – LTD applications and appeals have time-sensitive steps, and if you miss one, you may be at risk of a denial.
- Pre-existing condition exclusions – Sometimes, they’ll argue that your disability is related to a condition you had before your coverage started.
- Change in definition – After two years on LTD, the definition of “disabled” shifts from being unable to perform your own job to being unable to do any reasonably suitable job. That’s when many people suddenly get cut off.
According to the Office of the Superintendent of Financial Institutions (OSFI), over 13% of all LTD claims filed in Canada are denied or terminated within the first two years. This statistic is significant when considering how many people rely on these benefits to survive.
What can you do if your LTD claim has been denied?
Step 1: Don’t Panic, and Don’t Give Up
This might be the most important step. Being denied is frustrating, even infuriating, but it’s not uncommon or permanent. Your denial is a roadblock, but not the end of the road.
Most LTD denial letters include some explanation and information about how to appeal. While that may seem like the next logical step, it may not be (we will focus on appeals shortly).
Don’t do anything rash for now, like returning to work when you’re not ready or giving up altogether. You have options and can still get the compensation you deserve.
Step 2: Gather All the Paperwork
Start building your file:
- Your denial letter – Read it carefully. It should state the reason(s) for the denial.
- Your group benefits policy – This outlines the LTD coverage and any fine print the insurance company may rely on.
- Medical records and reports – The more up-to-date, the better.
- Correspondence with the insurance company – Save every email, phone call, fax, and mail you receive. Do not throw anything out.
- Your job description – This can help show how your condition affects your ability to do your actual work. List your day-to-day tasks and performance reviews, along with how long you have been in the position.
Organizing this info is crucial, especially if you need a lawyer.
Step 3: Talk to Your Doctor
Insurance companies frequently deny claims due to incomplete or vague medical documentation. Your doctor may have recorded “chronic fatigue” but failed to clarify how that fatigue affects your ability to perform your job. Alternatively, they might have employed clinical terms without illustrating the real-world impact on your daily life.
Go back to your doctor and ask for a more detailed letter or report. Ideally, it should outline:
- Your diagnosis and symptoms
- Your functional limitations (what you can’t do)
- Why you can’t perform the duties of your job
- The expected duration of your disability
If you’re seeing a specialist (like a psychiatrist, neurologist, or orthopedic surgeon), get them involved, too. Their opinion is important.
Step 4: Consider the Appeal – But Be Strategic
Most denial letters state that you have the right to appeal. While this may seem like a fair option, it is important to understand that internal appeals are managed by the same insurance company that initially denied your claim.
It’s like asking a referee to review their own bad call. Sure, you can appeal, and occasionally, it works, especially if you have new medical information, but it often burns valuable time.
In Ontario, you have two years from the date of denial to sue the insurance company. So if you spend 6-12 months on internal appeals that go nowhere, you’re just eating into that window.
We usually recommend getting legal advice before starting the appeal process. Sometimes a legal claim is stronger—and faster—than going in circles with the insurer.
Step 5: Contact a Toronto LTD Lawyer like Bergel Magence
The value of an experienced Personal Injury Lawyer specializing in LTD denials is immense.
At Bergel Magence, we’ve seen every kind of LTD denial you can imagine. We have seen people denied because they “looked okay,” because their job was “sedentary,” or because the insurer decided that their mental health struggles were not disabling enough. We understand how insurance companies work and have helped clients across Toronto and Ontario fight back against unfair LTD denials. Whether that means appealing, negotiating a settlement, or taking the insurer to court, we’ll guide you every step of the way.
The best part? We don’t get paid unless you win, so there’s zero risk in contacting us.
Why It’s Worth the Fight
You’ve paid into your long-term disability benefits through your job for years—now, when you need them, they’re suddenly out of reach? That’s not right.
Fighting an LTD denial can seem like an uphill battle, especially when you’re dealing with pain, anxiety, or exhaustion. But with the right legal team and solid documentation, many of these claims can be overturned—and many result in fair lump-sum settlements.
In fact, a 2023 report from Canadian Lawyer Magazine noted that most LTD lawsuits are resolved through settlement before trial, often for six-figure amounts, depending on the duration and severity of the disability.
Getting denied for long-term disability in Ontario is tough—but you’re not powerless.
Take a breath. Collect your records. Get your doctors on board. And most importantly, get legal advice before your time runs out.
At Bergel Magence, we treat our clients like family. If your LTD claim has been denied, let our family help yours. We’ll deal with the insurance company so you can focus on your health. Call Bergel Magence today at 416-665-2000 or visit us online at www.
