Fighting a denied or terminated LTD claim

LTD is the most-denied and most-fought coverage, so this playbook is the most detailed.

File thoroughly

LTD claims are won or lost on medical evidence. Get your treating physicians to document your restrictions and limitations in functional terms — the specific activities you can no longer do (sit, stand, concentrate, lift, work a full day), not just a diagnosis label. Complete the insurer's forms fully and meet every deadline. Keep copies of everything you submit and a dated log of every contact.

The elimination period

Benefits begin only after the waiting (elimination) period ends — commonly 90 or 120 days. Bridge that gap with short-term disability, EI sickness benefits, and savings so you're not without income while the claim is assessed.

The any-occupation switch

Most terminations cluster at around month 24, when the definition changes from own occupation to any occupation you're reasonably suited to by education, training, and experience. A cut-off at this point is not automatically valid — the insurer has to justify it against the policy's actual wording and your real capacity. If you genuinely can't work in any suitable occupation, a termination at the switch can and should be challenged.

Surveillance and independent medical exams

Insurers may schedule independent medical examinations (IMEs) and conduct surveillance. Be honest and consistent everywhere — your application, your doctors, social media, and daily life. Describe your condition accurately including your bad days, not just a good moment; a snapshot of you carrying groceries once doesn't define your capacity, but inconsistencies can sink a claim.

If you're denied or cut off

Work the sequence deliberately:

1. Request the full claim file and the specific medical and vocational basis for the decision, in writing.
2. Have your treating doctors respond directly to the insurer's stated reasons, in functional terms.
3. Submit an internal appeal in writing before the letter's stated window, with new evidence.
4. Escalate to OLHI (the OmbudService for Life & Health Insurance) if the internal appeal fails.
5. Consider a disability lawyer — many work on contingency, and involvement often changes the file's trajectory.

The Fight-Back Kit has letters for each step.

Deadlines

This is the trap that ends good claims: the appeal window in the denial letter is an internal deadline, not a legal one. Missing an internal appeal doesn't necessarily end your right to sue — but the limitation period (generally around two years, though it varies by province and facts) does. Never let it lapse while you negotiate. Confirm the actual date with a lawyer, and size the income shortfall with the Disability Gap tool.