Few things are more frightening than losing income while you are medically unable to work.
If your long-term disability (LTD) claim has been denied, you may feel frustrated, confused, or even ashamed. It is important to understand: denials are common — and often wrong.
Common Reasons LTD Claims Are Denied
Insurance companies frequently rely on predictable justifications:
- “Insufficient medical evidence”
- “You do not meet the definition of total disability”
- Pre-existing condition exclusions
- Surveillance interpretations
- Alleged treatment non-compliance
Often, the issue is not whether you are truly unable to work — but whether the insurer accepts the documentation.
Myth: If my doctor says I’m disabled, the insurer must approve me.
Reality: Insurers interpret policy definitions independently and may disagree with treating physicians.
The 24-Month Definition Change
Most LTD policies define disability differently after two years. Initially, you must be unable to perform your own occupation. After 24 months, you must be unable to perform any occupation reasonably suited to your background.
This change leads to many benefit terminations.
Appeal or Lawsuit?
Some policies allow internal appeals. However, internal reviews are still conducted by the insurance company.
In many cases, commencing legal action is the stronger strategy.
Why Acting Quickly Is Critical
There are limitation periods for filing lawsuits. Waiting too long can eliminate your ability to recover benefits.
You paid for disability coverage. You deserve the protection promised.
If your long-term disability claim has been denied in Ontario, contact Martin & Hillyer Associates immediately. Your income and stability depend on taking action now.