Long-Term Disability Claims

A long-term disability denial is not the end of your claim. But you have deadlines — and they may be shorter than you think.

A long-term disability denial letter is one of the worst pieces of mail you can open. You’ve been off work because you can’t do your job. The insurer has been paying your benefits — or you’ve been waiting for them to start. And now the insurer is saying no.

If your LTD claim has been denied or your benefits have been terminated, you have legal options. You also have deadlines that can move faster than people expect. This page explains how LTD denials work in Ontario, what your options are, and what to do next. It is general legal information, not legal advice for your specific situation.

How the limitation period works

The two-year limitation period comes from Ontario’s Limitations Act, 2002. It applies to most contract-based lawsuits, including breach of an LTD policy. Once the period passes, your right to sue can be permanently lost — even if your underlying claim was strong.

The clock generally starts on the date of a “clear and unequivocal denial.” But the wording of the denial letter, the wording of the policy, and the conduct of the insurer can all affect when that clock actually starts. In some cases, ambiguous language in a denial letter has been found not to trigger the limitation period at all. In others, a series of communications between the insurer and the claimant has shifted the start date.

Two practical points follow from this:

• Don’t assume the insurer’s internal appeal timelines are your only deadlines. They are separate from the legal limitation period.
• Don’t assume an internal appeal pauses the limitation period. In some cases it doesn’t, and people lose the right to sue while waiting for an appeal decision.

Common reasons LTD claims are denied

Insurers typically deny long-term disability claims for one of a handful of reasons:

• Insufficient medical evidence. The insurer takes the position that your medical records don’t support that you’re “totally disabled” under the policy definition.
• Policy definition disputes. Most LTD policies have two phases — the “own occupation” period and the “any occupation” period — and many denials happen at the transition.
• Surveillance or independent medical examinations. The insurer obtains video surveillance or commissions an Independent Medical Examination (IME) and uses it to argue you’re more capable than your treating doctors say.
• Pre-existing condition exclusions. The insurer claims your disability falls within a pre-existing condition clause in the policy.
• Documentation gaps. Late forms, missing physician statements, or non-attendance at scheduled assessments.
• Mental health and chronic pain claims. Claims based on conditions where objective medical evidence is harder to produce — including depression, anxiety, PTSD, fibromyalgia, and chronic pain — are denied at notably higher rates.

A denial doesn’t mean you don’t qualify for benefits. It means the insurer has taken a position. That position can be challenged.

The 24-month trap: “own occupation” vs. “any occupation”

This is one of the most common reasons people lose LTD benefits, and it’s worth understanding clearly.

Almost every group LTD policy has a definition of disability that changes around the 24-month mark:

• For the first 24 months, you’re considered disabled if you can’t perform the essential duties of your own occupation — the job you held when you became disabled.
• After 24 months, the definition typically shifts to any occupation for which you’re reasonably suited by education, training, or experience.

Insurers routinely terminate benefits at this transition. The reasoning is often that while you can’t do your old job, you could theoretically do some other job. These terminations are frequently based on vocational assessments that don’t reflect the realities of the local job market — particularly in Northwestern Ontario, where suitable alternative employment may not exist for someone with your limitations, training, and history.

A termination at the 24-month mark is not the end of your claim. The “any occupation” definition still requires the alternative work to be genuinely reasonable in light of your skills, training, education, and medical limitations. Many of these terminations are overturned.

Internal appeal vs. lawsuit: which path to take

Most LTD denial letters offer the option of an internal appeal. The letter often suggests this is the natural next step. It’s not always the right one.

An internal appeal

• Is reviewed by another adjuster at the same insurer
• Often relies on the same medical evidence the insurer already rejected
• Does not necessarily pause the two-year limitation period for suing
• Can be a reasonable choice when the denial appears to be based on a documentation gap that can be quickly cured

A lawsuit

• Compels the insurer to disclose its file, including internal notes and surveillance reports
• Allows you to obtain independent medical and vocational evidence
• Brings the matter before the courts, where the insurer’s decision is reviewed by a judge rather than its own staff
• Can include claims for unpaid past benefits, future benefits, and in some cases damages for the insurer’s conduct

The wrong assumption is that you must complete the internal appeal before suing. You don’t. And in some cases, focusing on the appeal causes the limitation period to run out. The right path depends on the specific denial, the policy wording, and the medical picture — which is why getting legal advice early matters.

What to do right now if you’ve been denied or terminated

1. Don’t sign anything from the insurer — particularly a release — without legal advice. A signed release can permanently end your claim.
2. Keep the denial or termination letter. The exact wording matters for limitation analysis.
3. Continue your medical treatment. Gaps in treatment are routinely used by insurers as evidence that you’ve recovered.
4. Get a copy of your policy. Your group benefits booklet, the master policy, and any amendments — these define the terms you’re being held to.
5. Track everything. Symptoms, treatment, daily activities, capacity to work, and any conversations or correspondence with the insurer.
6. Get legal advice early. Most personal injury and disability firms offer a free initial consultation. The earlier you get advice, the more options you preserve.

How White Macgillivray Lester helps with LTD claims

We act for clients across Northwestern Ontario whose long-term disability claims have been denied or terminated. Our LTD work includes:

• Reviewing denial and termination letters and policy wording
• Advising on whether to pursue an internal appeal, a lawsuit, or both
• Compiling the medical, functional, and vocational evidence needed to support a claim
• Negotiating with insurers and litigating where necessary
• Working with clients in Thunder Bay, Kenora, Dryden, Sioux Lookout, Marathon, Greenstone, Fort Frances, and surrounding communities — by phone, video, and in person where appropriate

How we work

Long-term disability cases at our firm are handled on a contingency fee basis. Under a contingency fee agreement, the lawyer is paid a percentage of the recovery rather than an hourly rate. If there is no recovery, no legal fee is owed. The percentage, and how disbursements (medical reports, expert opinions, court filing fees) and HST are handled, are set out clearly in a written agreement before you retain the firm.

Initial consultations are free. There is no obligation to retain the firm afterward. All consultations are confidential.

If you live outside Thunder Bay

You don’t need to travel to our office. We work with clients across Northwestern Ontario by phone and video. Initial consultations and most file communication can happen remotely. In-person meetings are arranged when needed.

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Frequently asked questions

How long do I have to challenge a long-term disability denial in Ontario?

The limitation period to sue an LTD insurer in Ontario is generally two years from the date of a clear denial, under the Limitations Act, 2002. The wording of your denial letter, the wording of the policy, and the conduct of the insurer can all affect when that clock starts running. An internal appeal does not necessarily pause the legal limitation period, so it is important to get legal advice before relying on the insurer’s internal timelines as your only deadline.

My long-term disability claim was denied. What are my options?

You generally have two paths: an internal appeal through the insurer, or a lawsuit against the insurer for breach of the policy. The internal appeal is reviewed by another adjuster at the same insurer and often relies on the same medical evidence. A lawsuit allows you to compel disclosure, obtain independent medical and vocational evidence, and have the matter reviewed by a court. Depending on the case, one path or the other may be more appropriate. Speaking with a lawyer before deciding can help avoid running out the limitation period.

I was approved for LTD, but now the insurer is cutting me off. Can they do that?

Insurers can and do terminate LTD benefits after initial approval. The most common termination point is the 24-month mark, when the policy definition typically changes from “own occupation” to “any occupation.” Terminations also commonly follow surveillance or an Independent Medical Examination (IME). A termination is not the end of your claim. The “any occupation” definition still requires the alternative work to be reasonable in light of your skills, training, education, and limitations. These terminations are frequently challenged.

What is the difference between “own occupation” and “any occupation”?

Most group long-term disability policies in Ontario have two phases. For the first 24 months, you are considered disabled if you cannot perform the essential duties of your own occupation — the job you held when you became disabled. After 24 months, the definition typically changes to “any occupation,” which requires you to be unable to perform the duties of any job for which you are reasonably suited by education, training, or experience. Insurers commonly terminate benefits at this transition based on vocational assessments that may not reflect the realities of the local job market.

Do I need a lawyer to appeal a long-term disability denial?

You are not required to have a lawyer to file an internal appeal with the insurer. However, an internal appeal does not always pause the two-year limitation period for suing, and the wrong choice of process can result in losing the right to sue. A lawyer can review your denial letter, your policy, and your medical evidence, and advise on whether an internal appeal, a lawsuit, or both is the appropriate path. Most personal injury and disability firms, including ours, offer a free initial consultation.

How much does it cost to hire a long-term disability lawyer?

Long-term disability cases in Ontario are typically handled on a contingency fee basis. Under a contingency fee agreement, the lawyer is paid a percentage of the settlement or judgment rather than an hourly rate. If there is no recovery, no legal fee is owed. Disbursements (medical reports, expert opinions, court filing fees) and HST are addressed separately in the written agreement. Ontario’s Solicitors Act and Law Society of Ontario rules require contingency agreements to be in writing and to set out the percentage clearly.

Can I sue my long-term disability insurer in Ontario?

Yes. If your LTD insurer has wrongfully denied or terminated your claim, you can sue for breach of the policy. A lawsuit can include a claim for unpaid past benefits, future benefits, and in some cases additional damages where the insurer has acted in bad faith. The general limitation period is two years from the date of a clear denial. Litigation also gives you tools that an internal appeal does not — including disclosure of the insurer’s file and the ability to obtain independent expert evidence.

What evidence do I need to support a long-term disability claim?

Strong LTD claims are typically supported by consistent medical treatment, detailed records from treating physicians, specialist reports where appropriate, and evidence of how the disability affects daily activities and the ability to work. Gaps in treatment are often used by insurers as evidence of recovery. Functional capacity evaluations and vocational assessments may also be relevant, particularly in “any occupation” disputes. A lawyer can help identify what additional evidence may strengthen the claim and arrange independent assessments where appropriate.