This article was updated on: July 20th, 2026

Receiving a letter that says your long-term disability (LTD) claim has been denied can feel overwhelming.

You may be asking yourself many questions.

  • How will I pay my bills?
  • What happens if I cannot work?
  • Should I appeal the decision?
  • Do I need a lawyer?

These are common concerns. A denied claim can create financial stress at a time when you should be focused on your health.

The good news is that a denial does not always mean your case is over.

Many people successfully challenge denied LTD claims. Some claims are approved after an appeal. Others are resolved after new medical evidence is provided. In some cases, legal action is needed to recover the benefits the insurance company refused to pay.

The key is knowing what to do next. The steps you take after receiving a denial letter can affect the outcome of your claim. Acting quickly, gathering the right evidence, and understanding your rights can make a big difference.

This guide explains why LTD claims are denied, what you should do after receiving a denial letter, how the appeal process works, and when you should consider speaking with a lawyer.

What Is Long-Term Disability Insurance?

Long-term disability insurance replaces part of your income if you cannot work because of an illness or injury.

Many people receive LTD coverage through their employer. Others purchase a private disability insurance policy.

If your claim is approved, your insurer will usually pay a percentage of your income each month while you remain disabled under the terms of your policy.

The amount you receive depends on your policy. Many plans replace between 60% and 70% of your regular income.

LTD benefits are designed to help people who cannot earn a living because of a serious medical condition.

People may qualify for benefits because of:

  • Chronic pain
  • Depression
  • Anxiety
  • Cancer
  • Heart disease
  • Multiple sclerosis
  • Arthritis
  • Fibromyalgia
  • Long COVID
  • Brain injuries
  • Autoimmune diseases
  • Serious back or neck injuries

Many people think a diagnosis alone is enough to qualify for LTD benefits.

It is not.

Insurance companies usually want to know how your condition affects your ability to work.

For example, two people may both have chronic back pain. One person may still be able to perform their job. The other may be unable to sit, stand, or lift for long periods.

Their diagnoses may be the same, but their ability to work is very different.

That is why insurers often focus on your symptoms, medical restrictions, and work limitations rather than your diagnosis alone.

Why Are Long-Term Disability Claims Denied?

Many people are shocked when their claim is denied. They assume that if their doctor says they cannot work, the insurance company will approve their application. Unfortunately, it does not always work that way.

Insurance companies review every LTD claim carefully before deciding whether to pay benefits. They may review:

  • Medical records
  • Doctor’s reports
  • Test results
  • Employer information
  • Job descriptions
  • Treatment history
  • Claim forms

After reviewing this information, the insurer decides whether you meet the definition of disability found in your policy. Sometimes the insurance company agrees that you have a medical condition but still believes you are able to work. Other times, the insurer believes there is not enough medical evidence to support the claim. A denial does not always mean the insurer believes you are healthy. It often means they believe they do not have enough evidence to approve the claim.

Understanding the reason for the denial is one of the first steps toward deciding what to do next.

The Most Common Reasons LTD Claims Are Denied

Insurance companies deny claims for many different reasons. Some denials are based on missing information. Others involve disagreements about your medical condition or your ability to work. Here are some of the most common reasons LTD claims are denied.

1. There Is Not Enough Medical Evidence

This is one of the most common reasons for a denial. Insurance companies need medical evidence to understand your condition.

Your records should explain:

  • Your diagnosis
  • Your symptoms
  • Your treatment
  • Your work restrictions
  • Why you cannot work

Sometimes a doctor’s note simply says, “Patient is unable to work.” While this may be true, it often does not provide enough detail for the insurance company. The insurer may want to know:

  • Why can’t you work?
  • What tasks can you no longer perform?
  • How long are the restrictions expected to last?

Without detailed answers, the insurer may deny the claim.

2. The Insurance Company Believes You Can Still Work

Sometimes the insurer agrees that you have a medical condition. However, it may decide that you are still capable of doing your job.

In other cases, the insurer may believe you cannot perform your current job but could work in another occupation. This often happens when there is little information about your actual job duties. For example, someone may have an office job that requires long periods of sitting and computer work.

If the insurer does not understand those demands, it may wrongly assume the person can still work. Detailed medical reports and accurate job descriptions are often important in these cases.

3. Important Information Was Missing

Insurance companies rely on documents when reviewing a claim. If important records are missing, they may deny the application.

Examples include:

  • Missing medical records
  • Incomplete claim forms
  • Missing specialist reports
  • Missing employer forms
  • Missing test results

Sometimes a claim is denied simply because the insurer believes it does not have enough information to make a decision. This is one reason it is important to review your claim carefully before submitting it.

4. Your Doctor Does Not Fully Support Your Claim

Your doctor’s opinion plays an important role in an LTD claim.

If your doctor says you can return to work or provides unclear information, the insurance company may rely on those opinions. Sometimes doctors also underestimate how much a condition affects a person’s ability to work. A detailed medical report often carries much more weight than a short note. It should explain not only your diagnosis but also how your symptoms affect your ability to perform your job every day.

5. You Do Not Meet the Policy’s Definition of Disability

Every long-term disability policy is different.

The definition of “disabled” is one of the most important parts of your policy. Many policies use two different definitions.

During the first part of your claim, you may only need to show that you cannot do your own job. After a certain amount of time, the definition often changes. The insurance company may then ask whether you can perform any job that matches your education, training, or experience.

This change surprises many people. Someone who qualified for benefits during the first two years may later be told they no longer meet the new definition of disability.

Understanding your policy can help you understand why a claim was denied or why benefits stopped.

6. The Insurance Company Believes You Have Recovered

Sometimes an insurer decides that your condition has improved enough for you to return to work. This may happen after reviewing updated medical records or receiving information from your doctor.

In other cases, the insurer may rely on an independent medical examination or surveillance. You may strongly disagree with that decision. If so, updated medical evidence from your treating doctors may help explain why you are still unable to work.

7. You Missed Medical Treatment

Insurance companies often expect people receiving LTD benefits to follow their treatment plans. If you stop treatment without a good reason, the insurer may question your claim.

For example, they may ask why you stopped:

  • Physiotherapy
  • Counselling
  • Specialist appointments
  • Recommended testing
  • Rehabilitation programs

Sometimes there are good reasons for missing treatment. You may have been waiting for a specialist, unable to afford treatment, or advised by your doctor to stop. If that is the case, make sure the insurer understands why your treatment changed.

8. The Insurer Says Your Condition Is Not Severe Enough

Not every illness or injury qualifies for LTD benefits. The question is not whether you have a medical condition: the question is whether that condition prevents you from working.

For example, two people may both have migraines. One may only experience occasional headaches and continue working. Another may have migraines several times each week that make it impossible to work. The diagnosis is similar, but the impact on daily life is very different.

Insurance companies often focus on how your condition affects your ability to work rather than the name of the condition itself.

9. There Are Problems With the Paperwork

Even small mistakes can slow down a claim. Incorrect dates, missing signatures, incomplete forms, or inconsistent information may lead to questions from the insurer.

Before sending any documents, review everything carefully. If possible, ask someone else to review your forms as well. Taking a little extra time may help prevent unnecessary delays.

10. The Insurance Company Questions Your Credibility

Insurance companies look for consistency. They compare information from many sources.

This may include:

  • Medical records
  • Claim forms
  • Doctor’s reports
  • Employer information
  • Surveillance
  • Social media

If the information does not match, the insurer may question your claim. For example, your doctor may report that you cannot sit for more than 20 minutes.

If another report says you regularly drive several hours each day, the insurer may ask questions. This does not always mean the claim should be denied. However, it shows why accuracy is important throughout the claims process.

What Should You Do After Your LTD Claim Is Denied?

Receiving a denial letter can feel discouraging. Many people feel angry, confused, or frustrated. Some assume there is nothing they can do. Others immediately start gathering paperwork without knowing what the insurer is actually asking for.

Neither approach is helpful. Instead, take a step back and make a plan. The actions you take during the first few weeks after a denial can have a big impact on your claim.

Step 1: Read the Denial Letter Carefully

Start by reading the denial letter from beginning to end. Do not skim it. Read it carefully. The letter should explain why your claim was denied.

It may also include:

  • The medical evidence the insurer reviewed
  • The policy provisions they relied on
  • Information they believe is missing
  • Instructions for filing an appeal
  • Important deadlines

Highlight anything you do not understand. Make a list of questions.

The denial letter is one of the most important documents in your claim because it tells you exactly why the insurer made its decision.

Step 2: Understand Why the Claim Was Denied

Not all denials are the same. Some claims are denied because information was missing. Others are denied because the insurer disagrees with your doctor’s opinion. Some involve both issues.

Before doing anything else, identify the main reason for the denial.

Ask yourself:

  • Does the insurer need more medical evidence?
  • Did they misunderstand my job duties?
  • Did they rely on an outdated medical report?
  • Did they say I can return to work?
  • Did they say I no longer meet the policy definition of disability?

Answering these questions will help you decide what evidence you need before moving forward.

Step 3: Do Not Miss Any Deadlines

Many LTD policies have strict deadlines for appeals. Missing a deadline can make your claim much harder to resolve.

As soon as you receive the denial letter, write down every important date. Do not wait until the last week to begin gathering medical records.

Some records can take weeks to obtain. Starting early gives you more time to prepare a stronger response. If you are unsure about a deadline, contact the insurer or speak with a lawyer as soon as possible.

Should You Appeal a Denied LTD Claim?

In many cases, yes.

An appeal gives the insurance company another chance to review your claim. It also gives you the chance to submit new information that was not included the first time.

However, an appeal is not simply a request for the insurer to “look again.” A strong appeal should answer the reasons given in the denial letter. For example, if the insurer says there is not enough medical evidence, your appeal should include stronger medical reports.

If the insurer says you can still work, your appeal should explain why your condition prevents you from doing your job. The stronger your evidence, the stronger your appeal may be.

Step 4: Gather Stronger Medical Evidence

Medical evidence is the foundation of every LTD claim.

Without strong medical evidence, it can be difficult to convince an insurer to change its decision.

Start by reviewing the denial letter.

Then compare the insurer’s concerns with the medical information already in your file.

Ask yourself:

  • Do my records explain my symptoms?
  • Do they explain my work restrictions?
  • Do they explain why I cannot return to work?
  • Are they current?

If the answer to any of these questions is no, your appeal may need stronger evidence.

Helpful evidence may include:

  • Updated medical records
  • Specialist reports
  • Diagnostic imaging
  • Laboratory results
  • Functional capacity evaluations
  • Occupational therapy reports
  • Psychological assessments
  • New treatment records

Insurance companies usually want more than a diagnosis.

They want to understand how your condition affects your daily life and your ability to work.

Ask Your Doctor for a Detailed Report

Many LTD claims are denied because the doctor’s report is too short.

A brief note saying you are “unable to work” is often not enough.

Instead, ask your doctor to prepare a detailed report.

A good report should explain:

  • Your diagnosis
  • Your symptoms
  • Your treatment plan
  • Your physical restrictions
  • Your mental or cognitive limitations, if any
  • Why you cannot perform your job
  • Whether your condition is expected to improve

The report should also explain how your condition affects your ability to complete a normal workday.

For example, your doctor may explain that you cannot sit for long periods, lift heavy objects, concentrate for extended periods, or manage workplace stress.

These details often matter much more than the diagnosis itself.

Step 5: Gather Other Evidence

Medical records are important, but they are not the only evidence that can support your claim.

Depending on your situation, you may also wish to gather:

  • A detailed job description
  • Letters from your employer
  • Statements from family members
  • Statements from co-workers
  • A list of your daily symptoms
  • Information about medications and side effects

For example, your employer may be able to explain why your job requires long periods of standing, lifting, driving, or concentrating. Your family may be able to describe how your condition affects your daily life at home.

Together, this evidence can help create a clearer picture of how your disability affects you.

Step 6: Keep Good Records

Good organization can make your claim much easier to manage. Create one folder for everything related to your LTD claim.

Keep copies of:

  • The denial letter
  • Medical records
  • Appeal letters
  • Emails
  • Forms
  • Specialist reports
  • Test results

If you speak with the insurance company by phone, make notes after every conversation.

Write down:

  • The date
  • The time
  • The name of the person you spoke with
  • What was discussed

These notes may be useful if there is a disagreement later.

Keep a Daily Symptom Journal

A symptom journal can also help support your claim. You do not need to write several pages each day. Short notes are often enough.

Record things such as:

  • Your pain level
  • Fatigue
  • Sleep problems
  • Medication side effects
  • Activities you could not complete
  • Medical appointments
  • Days when your symptoms became worse

Over time, this journal can help show how your condition affects your daily life. It may also help your doctor prepare more detailed reports.

Common Mistakes People Make After an LTD Claim Is Denied

Many people make mistakes after receiving a denial letter. These mistakes are understandable. Receiving a denial is stressful, and many people are unsure what to do next.

Knowing what to avoid may help strengthen your claim.

Waiting Too Long

Some people put the denial letter in a drawer and hope the problem will go away. Others feel overwhelmed and do nothing for weeks.

Unfortunately, waiting can make things worse. Appeal deadlines can pass, and it may become harder to gather medical evidence. Acting early usually gives you more options.

Sending an Appeal Without New Evidence

One of the biggest mistakes is submitting an appeal that simply says the insurance company made the wrong decision.

Most insurers expect new information. If your appeal contains the same documents that were already reviewed, the insurer may reach the same decision again. A stronger appeal usually includes updated medical records, detailed reports, or other new evidence.

Stopping Medical Treatment

Continue attending medical appointments unless your doctor tells you otherwise. Insurance companies often expect people receiving LTD benefits to continue treatment. If you stop treatment without a clear reason, the insurer may question whether your condition is as serious as you claim.

If your treatment changes, make sure your medical records explain why. For example, you may have completed a treatment program, been referred to a specialist, or been advised to try a different form of treatment. Clear medical records can help prevent misunderstandings.

Returning to Work Too Soon

Many people feel pressure to return to work after their claim is denied. You may be worried about paying your bills or supporting your family. That pressure can make it tempting to return before you are medically ready.

However, returning too soon can affect both your health and your claim. If you return to work and cannot perform your duties, your symptoms may become worse. It may also become harder to show that you were unable to work during the period your claim was denied.

Before returning to work, speak with your doctor. If your doctor believes you can try returning on modified duties or reduced hours, make sure those recommendations are clearly documented.

Ignoring Requests From the Insurance Company

Even after denying your claim, the insurance company may continue asking for information.

For example, they may request:

  • Updated medical records
  • New claim forms
  • Specialist reports
  • Employment information
  • Details about your treatment

Do not ignore these requests. If you need more time to collect the information, let the insurer know. Good communication may help prevent further delays.

Can Social Media Affect Your LTD Claim?

Yes.

Many insurance companies review social media while investigating disability claims. A single photo or short video rarely tells the whole story. It does not show your pain, fatigue, or symptoms before or after the picture was taken.

Unfortunately, social media posts can sometimes be taken out of context. For example, a picture from a family gathering may be used to suggest you are more active than you reported.

This does not mean you must stop using social media. It does mean you should think carefully before posting.

While your claim is active, consider:

  • Limiting what you post
  • Avoiding photos that may be misunderstood
  • Reviewing your privacy settings
  • Asking friends and family not to tag you without your permission

Being careful online can help avoid unnecessary questions from the insurer.

Can the Insurance Company Conduct Surveillance?

Yes.

Insurance companies sometimes use surveillance when reviewing disability claims. Surveillance does not happen in every case, but it is legal in many situations. An insurer may:

  • Observe you in public places
  • Record video in public
  • Review public social media posts
  • Compare surveillance with your medical records

Surveillance alone does not prove someone is able to work. However, if the insurer believes your activities do not match your reported restrictions, it may use that information to question your claim.

The best way to protect yourself is to be honest about your condition and follow your doctor’s advice.

Should You Hire a Lawyer?

Not every denied claim requires a lawyer.

However, many people benefit from getting legal advice after a denial. A lawyer can explain your rights and review your insurance policy. They can also explain why your claim was denied and what evidence may improve your case.

You may want to speak with a lawyer if:

  • Your claim has been denied
  • Your appeal was unsuccessful
  • Your benefits were stopped
  • The insurer says you can return to work
  • You are unsure what to do next

Many people wait until they feel they have no options left. In many cases, it is better to get legal advice sooner. A lawyer may identify problems before they become more difficult to fix.

Can You Sue the Insurance Company?

Sometimes.

If your claim was wrongly denied, legal action may be an option. Not every denied claim ends up in court. Some cases settle before a lawsuit is started. Others settle after a lawsuit has been filed.

Every case is different. A lawyer can review your policy, the medical evidence, and the reasons for the denial before recommending the best course of action.

How Long Do You Have to Challenge a Denied Claim?

Time limits apply to LTD claims. The amount of time you have depends on your policy and the laws that apply to your case.

Waiting too long may affect your legal rights. For that reason, do not ignore a denial letter or assume you can deal with it later. If you are unsure how much time you have, speak with a lawyer as soon as possible.

Frequently Asked Questions

Should I accept the insurance company’s decision?

Not always. Some denied claims are later approved after stronger medical evidence is provided. Before accepting the decision, make sure you understand why your claim was denied and what options are available.

Can I submit new medical evidence?

Yes. New medical records, specialist reports, and updated test results may strengthen your claim. Your doctor may also be able to provide a more detailed report that addresses the insurer’s concerns.

What happens if my appeal is denied?

You may still have options. Depending on your situation, you may be able to negotiate with the insurer or start a lawsuit. A lawyer can explain which option may be best for your case.

How long does an LTD appeal take?

There is no set timeline. Some appeals are decided within a few weeks. Others may take several months. The timeline depends on the insurer, the medical evidence, and the issues involved in your claim.

How NOVA Injury Law Can Help

A denied LTD claim can leave you feeling stressed and uncertain about the future. You may be dealing with a serious medical condition while also worrying about your income and your family’s financial security.

At NOVA Injury Law, we help people across Atlantic Canada understand their rights after an LTD claim has been denied. Our team can review your policy, explain the insurer’s decision, gather supporting evidence, and help you decide on the best next step.

Whether you are considering an appeal or legal action, we are here to help. If your long-term disability claim has been denied, contact NOVA Injury Law for a free consultation.

Final Thoughts

Receiving a denial letter does not always mean your claim is over. Many people successfully challenge denied LTD claims by providing stronger medical evidence or taking legal action when needed.

The most important thing is to act quickly. Read your denial letter carefully. Keep good records. Continue your medical treatment. Learn about your rights before making any decisions.

If you believe your long-term disability claim was wrongly denied, speaking with an experienced lawyer can help you understand your options and protect your rights.

This article is for informational purposes only and does not constitute legal advice.