Having your long-term disability (LTD) claim denied can add stress and worry to an already challenging situation. In this article, we provide you with the logical steps you can take following a denial letter to guide you towards a resolution.

Review The Decision

In some cases, a denial may occur because the insurer lacks sufficient information to support a finding of disability under the contract. Insurers are required to provide a written letter with reasons for the denial. If reasons are unclear or missing, contacting the insurer for clarification can sometimes quickly resolve the issue. A denial may be due to missing medical documentation, which can be rectified by providing the requested records. If the denial persists even after submitting all documentation, you can request a review of the decision within a specified timeframe, typically 30 to 60 days. Occasionally, this review can lead to a reversal of the denial.

Good Faith Contract

Long-term disability contracts, like all insurance contracts, are based on good faith. Both the insured and the insurer have mutual obligations to act honestly and fairly. The insured must provide factual information and adhere to the contract terms, while the insurer must adjust claims in good faith, swiftly, and honestly. Delays, failure to provide reasons, or arbitrary decisions may breach this contract. 

Own Occupation vs. Any Occupation Test

Understanding the criteria for receiving LTD benefits is crucial. Initially, you must meet the “Own Occupation” test, proving you cannot perform your job’s essential duties. After two years, the “Any Occupation” test applies, requiring proof that you cannot perform any job for which you are reasonably qualified. The “any” job must offer a meaningful income, usually 60% of pre-disability earnings. If your claim is denied from the start, the insurer believes you do not meet the “Own Occupation” test. If benefits are denied after two years, it may be due to the “Any Occupation” test. Expect requests for medical assessments and documentation around the two-year mark.

Limitation Period

Once your LTD claim is denied, the limitation period begins, typically two years from the denial date, though some policies may have a shorter period. This period is the time you have to file a claim in court. Missing this deadline could prevent you from pursuing your entitlement to benefits.

Duration Of Benefits

LTD benefits usually last until age 65, but some policies may cap the duration. An unexpected denial could be due to the expiry of this term in your policy.

Navigating a denial can be complex, given the interaction of your medical history with legal requirements and Ontario laws. Consulting a disability lawyer promptly is crucial. The legal team at Singer Kwinter – a proud partner of Vaughan Health & Wellness Expo, has extensive experience in challenging denials and securing benefits, offering valuable guidance and support. Come, visit our booth at the Health & Wellness Expo on 26 Oct  2025 at Vellore Village Community Centre – 1 Villa Royale Ave, Woodbridge from 11am to 5pm. Admission is Free!