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 turn on medical evidence. Get your treating physicians to document your restrictions and limitations in functional terms (what you can't do), not just a diagnosis. Meet the insurer's forms and deadlines exactly.

The elimination period

Benefits start only after the waiting period; keep income flowing (STD, EI sickness, savings) until then.

The any-occupation switch

Many terminations happen at around month 24 when the definition changes from own-occupation to any-occupation. A termination at this point isn't automatically valid — it must be justified against the policy's actual wording and your real capacity.

Surveillance and IMEs

Insurers may use independent medical exams and surveillance. Be honest and consistent; describe your bad days accurately, not just your best day.

If denied or cut off

Request the full claim file and the specific medical/vocational basis for the decision; get your doctors to respond to the insurer's stated reasons; submit an internal appeal in writing before the deadline; then OLHI; then consider a disability lawyer (many work on contingency) — a lawyer's involvement often changes the file's trajectory.

Deadlines

Appeal windows in the denial letter are internal, not legal deadlines — missing an internal appeal doesn't necessarily end your right to sue, but the limitation period (generally ~2 years, confirm for your province) does. Don't let it lapse. Size the shortfall with the Disability Gap tool.