LTD Claim Denied in Ontario: Your Complete Legal Options

Why Valid LTD Claims Get Denied

Long-term disability insurers in Ontario routinely deny legitimate claims. Common stated grounds include: the claimant does not satisfy the policy’s disability definition; the condition is pre-existing; the claimant failed to participate in rehabilitation; or medical evidence is deemed insufficient. An experienced LTD lawyer scrutinizes every stated ground against actual policy language and the medical record.

Step 1 — Read the Denial Letter Carefully

A denial letter must identify the specific policy provision relied on and the factual basis for refusal. Compare every stated reason against the exact text of your LTD policy. Insurers sometimes invoke exclusion clauses that do not actually apply to your condition.

The limitation period trap: Ontario courts apply a two-year limitation period to LTD lawsuits, running from the date you knew or ought to have known your claim was denied. The Supreme Court’s decision in Kassburg v. Sun Life confirmed this clock can start earlier than claimants expect. Consult a lawyer within weeks of any denial.

Step 2 — Internal Appeal

Most group LTD policies include an internal appeal process. An appeal can succeed — particularly when new specialist reports, functional capacity evaluations, or updated diagnostic evidence are available. Any appeal letter should be drafted by a lawyer to preserve legal arguments and avoid making admissions.

Step 3 — Civil Lawsuit

An LTD dispute proceeds as a breach of contract claim in the Ontario Superior Court of Justice. You sue for all denied monthly benefits to date, a declaration of continued entitlement, interest on arrears under the Courts of Justice Act, and — where warranted — punitive damages for bad faith. Most LTD cases resolve through discovery, examinations, and mediation before trial.

Expert Evidence Is Decisive

The insurer relies on physicians who review your file without examining you. Your lawyer must retain independent treating experts who can explain your functional limitations in terms courts recognize as credible. The quality of your medical evidence frequently determines outcome.