Your Long-Term Disability Claim Was Denied. Here Is What to Do Next.

A denial does not mean the end of your claim. It means the fight is just beginning.

You have been off work due to illness or injury. You filed a long-term disability claim with your insurance company expecting the coverage you paid for. Then a letter arrived telling you your claim has been denied. It is one of the most frustrating and frightening things a person can receive, especially when you are already dealing with a health crisis.

The important thing to understand is this: a denial is not final. Insurance companies deny legitimate claims every day, and many of those denials are successfully overturned. Here is what you need to know about why LTD claims get denied, what your options are, and what steps to take right now.

Why Do Insurance Companies Deny Long-Term Disability Claims?

Understanding why your claim was denied is the first step toward challenging it effectively. Insurers in Atlantic Canada most commonly deny claims due to insufficient objective medical evidence, the switch from own-occupation to any-occupation definitions at 24 months, insurer-commissioned IMEs, pre-existing condition exclusions, and surveillance evidence. For a detailed breakdown of each reason, see our guide on LTD claim denials.

Step 1: Read the Denial Letter and Request Your Full Policy

The denial letter must state the specific reason your claim was denied. Read it carefully and note every ground the insurer has cited. If the letter is vague, you have the right to request a more detailed explanation.

At the same time, request a complete copy of your insurance policy, your certificate of coverage, and your claims file. You are entitled to these documents. Your policy is the contract between you and the insurer, and the terms of that contract will govern any appeal or legal action. Many claimants have never actually read their full policy, and the specific language around disability definitions, exclusions, and appeal procedures matters enormously.

If you are unsure whether you even qualify to make a claim, our guide on LTD eligibility walks through the key criteria.

Step 2: Do Not Sign Anything or Give a Recorded Statement

If the insurer contacts you after a denial asking for a recorded statement, additional medical authorizations, or any documents to sign, do not comply before speaking with a lawyer. Adjusters may frame these requests as routine or helpful, but they are often designed to gather information that supports the denial rather than reverses it.

Broad medical authorizations in particular can give the insurer access to your entire medical history, which they may use to find pre-existing conditions or other grounds to justify the denial. If you have any doubts, get a legal opinion on your insurance dispute first.

Step 3: Know Your Deadlines

This is one of the most critical steps and one of the most commonly missed. LTD denials come with strict timelines that you must respect or risk losing your right to appeal or sue.

Most group LTD policies require you to file an internal appeal with the insurer within 60 to 90 days of the denial letter. If you miss this window, you may be required to go directly to litigation, or in some cases, you may lose your right to challenge the denial entirely depending on the policy terms.

Beyond the internal appeal, there is also a limitation period under provincial law in New Brunswick, Nova Scotia, and Prince Edward Island. This is typically two years from the date the insurer denies or terminates your claim, though the specific start date can vary. A lawyer can help you calculate your exact deadlines and make sure no option is lost through inaction.

Step 4: Strengthen Your Medical Evidence

The most effective way to reverse an LTD denial is to address the gap in medical evidence the insurer has identified. Work with your treating physicians to ensure your file includes current and detailed clinical notes, specialist reports, functional assessments, and any objective test results relevant to your condition.

For conditions like depression, anxiety, PTSD, chronic pain, or fibromyalgia, where objective evidence is harder to produce, it is especially important to have specialist involvement. A psychiatrist, psychologist, rheumatologist, or pain specialist can provide the kind of documented clinical findings that insurance companies cannot easily dismiss. Your lawyer can help identify which type of evidence is most likely to address the specific grounds of your denial.

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Step 5: File an Internal Appeal or Pursue Legal Action

Once you have gathered your documentation and consulted with a lawyer, you have two main paths forward. The first is the internal appeal process, which is built into most group policies. This involves submitting new or additional medical evidence and a written argument for why the denial was incorrect. Internal appeals are resolved by the insurer itself, which means they are not neutral, but they can sometimes succeed, particularly when the denial was based on missing documentation that has now been supplied.

The second path is litigation. If the internal appeal fails or the policy does not provide one, your lawyer can file a claim in court. Courts in Atlantic Canada have consistently ruled in favour of claimants in LTD cases where the insurer acted unreasonably, applied definitions too broadly, or failed to properly weigh medical evidence. In some cases where the insurer's conduct was particularly egregious, courts have also awarded punitive damages on top of the benefits owed.

What About CPP Disability?

If you have not already applied for CPP Disability benefits, a denial of your LTD claim is a good time to consider it. CPP Disability is a federal benefit for people who have contributed to the Canada Pension Plan and are unable to work regularly at any job due to a severe and prolonged disability.

Applying for CPP-D does not replace your long-term disability claim. In fact, most LTD policies require you to apply for CPP-D, and if approved, the monthly benefit is typically deducted from your LTD payment. But a CPP-D approval can also serve as supporting evidence in your LTD appeal or litigation, since it represents a separate government body's finding that you are unable to work.

You Do Not Have to Fight This Alone

CLG Injury Law has been representing people with denied and terminated disability claims across New Brunswick, Nova Scotia, and Prince Edward Island for nearly 40 years. We know how insurance companies build their denials, and we know how to challenge them.

If your LTD claim has been denied or cut off, reach out to us. The consultation is free, there is no obligation, and you pay nothing unless your case is successful. You have already been through enough. Let us handle the fight from here.