Your long-term disability claim has been denied, the letter runs to a page or two, and the income you were counting on has stopped or is about to stop. That is frightening, and it is also a normal stage of a contract dispute rather than the end of the road. Long-term disability is income replacement bought under a policy, so a denial is the insurer saying the conditions in that policy have not been met. It is a decision by one party to a contract, which means a denied long-term disability claim is the beginning of a dispute and not the close of the claim.
There is one thing worth knowing today, before anything else. A deadline is already running, and the date it runs from is measured from the documents in your own file, not from the date printed on the letter.
Long-Term Disability Denied: What to Do in the First Week
Five things protect your position in the first week, and all five can be done before you speak to anyone.
- Write the date you received the denial letter on the letter itself, keep the envelope, and save the email it arrived with.
- Ask the insurer in writing for your complete claim file, including the adjuster’s notes, every internal medical review, and all correspondence.
- Ask your employer or plan administrator, in writing, for the master policy document rather than the short employee booklet you were handed.
- Work out your deadline to start a lawsuit before you decide anything else, including whether to use the insurer’s appeal process.
- Keep treating, keep every appointment, and make sure each visit and each referral is recorded in your medical chart.
Start With the Deadline, Not the Appeal
Most people reach for the appeal form first, because the letter invites them to. Start somewhere else. The insurer’s appeal process and the legal deadline to sue run at the same time and are not the same thing, and the deadline is the one that cannot be recovered once it has gone.
The Two-Year Deadline in Ontario
Ontario sets one general deadline for starting a court case, and it is 2 years from the day the claim was discovered. That rule comes from the Limitations Act, 2002, and it is the rule that governs a dispute with a disability insurer, because a group disability claim is a contract claim like any other.
Missing that deadline does not mean your claim was weak. It means a court will not hear it at all. Strong medical evidence, a sympathetic doctor and an insurer who handled the file badly all count for nothing once the period has run.
When the Clock Starts Is a Question of Fact
The 2 years do not automatically run from the date printed on your denial letter. The law measures from the day you knew, or the day a reasonable person in your circumstances should have known, three things: that you had lost something, that the insurer was the one who caused the loss, and that going to court was a sensible way to deal with it.
Here is the part that catches people. In 2021 the Court of Appeal for Ontario decided a case called Kumarasamy, and it held there is no rule requiring a clear, unmistakable denial before the clock can start. A claimant can be out of time even where the insurer never sent a clean refusal.
So your start date is not something to guess at. It is worked out from the documents in your own file: the letters, the dates benefits stopped, and what you were told at each stage. That is a reason to have someone read them early rather than late, because the answer decides how much time you actually have.
Does an Appeal Buy You More Time?
It depends on your file. An appeal to the insurer and the deadline to sue are two separate processes, and appealing does not reliably stop the second one. Ontario courts have looked at insurer appeal processes differently depending on what the insurer actually wrote and when, so nobody can promise you that appealing buys time. Work out your deadline first. Then decide whether to appeal.
The pattern that costs people the most is a slow one. You send more medical every few months, the insurer says it will take another look, months turn into a second year, and no proceeding is ever started. Each round feels like progress, and none of it answers the separate question of when your time to sue runs out.
If Your Policy Says You Have One Year
Plenty of group disability policies contain a clause that shortens the time to sue to 1 year, and insurers do point to it. Ontario’s Court of Appeal has held that a group disability policy is not the kind of commercial bargain the law allows to cut that period down, because coverage of this sort serves personal purposes rather than business ones. In that case the 1 year clause could not be enforced, and the 2 year statutory period applied instead.
That clause does not live in the booklet your employer gave you. It sits in the master policy between the employer and the insurer, which is one more reason to ask for the policy document itself. Wording varies from plan to plan, so no one outcome is guaranteed to repeat.
The practical point is simple. If you have been told your time ran out after a year, that is worth having checked before you accept it.
Read the Denial Letter and Find the Stated Reason
The letter is the map. Everything you do next is aimed at the reason the insurer put in writing, not at your diagnosis and not at how unwell you feel. Then notice which kind of decision it is: a refusal of a claim that was never paid, or a decision to stop benefits you were already receiving. Those are different events, and what the deadline runs from is not the same in both.
What Denial Letters Usually Say
Denial letters tend to say one of a handful of things. The medical information does not show you cannot work. The restrictions your doctor describes do not match what the insurer’s own consultant or its investigator observed. Treatment stopped, or never really started. The condition falls under a pre-existing condition clause. A form was not returned, or a deadline was missed.
Then there is the change of definition. Many policies test whether you can do your own job for about the first 24 months and then switch to whether you can do any job you are reasonably suited to, and a lot of terminations land at that switch.
Answering the Reason, Not the Diagnosis
The insurer is not really asking what condition you have. It is asking what you cannot do, for how long, and how often. Those are different questions, and many files answer only the first one.
Compare two ways of describing the same person. The first says chronic back pain, ongoing. The second says cannot sit longer than 20 minutes, cannot lift above shoulder height, and needs to lie down twice in a working day. The first describes a diagnosis, which the insurer already accepts. The second describes function, which is what the denial questioned, and it is the version that answers the letter.
Get the Insurer’s File and Your Actual Policy
Most denied claimants argue with a decision they have never read the reasoning for. Two documents change that: the insurer’s file on you, and the policy that actually governs your coverage. Both can be obtained without a lawsuit, without a lawyer, and without anyone’s permission.
Your Right to See What the Insurer Has on File
Federal privacy law gives you the right to get the personal information a business holds about you, and an insurer is a business. For a disability claimant that reaches a long way: the adjuster’s notes, the internal medical consultant’s review of your file, the correspondence about your claim, and any surveillance report. It is a right to your own personal information rather than to every document the insurer owns.
The request has to be in writing. The insurer is expected to respond within 30 calendar days, and it may take up to another 30 days in specific circumstances if it tells you so. It should cost you little or nothing. If material is held back that should not be, you can complain to the Privacy Commissioner of Canada.
Ask for the complete file rather than “my claim information”. Name what you want: adjuster and case manager notes, all internal and external medical reviews, any investigation or surveillance material, and all correspondence about the claim. Date the letter, send it in a way that produces proof of delivery, keep a copy, and mark the 30 day date in your calendar. An incomplete answer is common, and asking again, specifically, usually produces more.
The Booklet Is Not the Policy
What you were given at work is a certificate or booklet, a short summary written for employees. What governs your claim is the master policy between your employer and the insurer, and the two are not always consistent. Ask your employer’s HR or benefits contact, or the plan administrator, in writing, for the policy that was in force on the date you stopped working. That date matters, because the terms that apply to you are the ones in effect when your disability began, not the ones in effect today.
What to Do With What Comes Back
Read the file against the stated reason for the denial, not from the first page forward. Find what the insurer’s own consultant said, and check whether that person ever examined you or only read paper. Find the stretches with no treatment records, because a gap reads as recovery even when the real reason was cost or a waiting list. Find anything where activity was recorded, and work out whether you can explain it. That is what turns a stack of paper into a plan.
Build the Evidence That Answers the Stated Reason
The reason in the letter is the target. Evidence that does not aim at it, however sympathetic, tends to produce the same answer a second time. That holds when the stated reason is administrative rather than medical, so start from the letter and work back to the doctor, not the other way around.
Ask Your Doctors About Function, Not Diagnosis
A note saying you are unwell and off work rarely moves a claim. What moves it is a treating physician willing to put restrictions and limitations in writing, in measurable terms, with the clinical reasons behind them. Ask for it in those words: how long you can sit, stand and walk, what you can lift, how long you can concentrate, and how often symptoms interrupt a working day. Some physicians will go no further than sympathy. That is useful to learn early, while there is still time to find an assessment that will.
Keep Treatment Going and Keep It on the Record
Consistent, documented treatment is the easiest part of a disability claim for you to control, and the easiest to lose. A stretch of missed appointments gets read later as a person who got better, whatever the real reason was. If cost or a waiting list is the barrier, say so to your treating physician and ask that the reason go in the chart. Low cost options count as treatment too, and they keep the record continuous. A recorded reason for a gap is a different document from an unexplained silence.
Independent Assessments and Who Pays for Them
There are two kinds of assessment in these files. One is arranged by the insurer, by a physician it selects and pays. The other is arranged by your side, and a functional capacity assessment often carries more weight than another specialist opinion, because it measures what you can do over a working day rather than restating the diagnosis. When a firm takes a disability case on contingency, assessments are usually funded as disbursements and repaid out of the result. If you are paying privately, ask what the report is meant to prove before you pay for it.
Appeal, Complain, or Sue: What Each Route Actually Gets You
Three routes are open to you after a denial. They are not steps in a sequence, you are not required to work through them in order, and only one of them ends in a decision that binds the insurer. The differences that matter are who decides, whether the outcome can be enforced, and what each one does to your time to sue.
| Route | Who decides | Is the outcome binding | Effect on your deadline to sue |
| Internal appeal to the insurer | The insurer, reviewing its own decision | No. The insurer can keep its position | No promise of more time. Whether your appeal affects your deadline depends on the facts of your file, so work the deadline out first |
| Complaint to OLHI | An independent ombudservice, at no cost to you | No. The outcome is a recommendation, and OLHI does not award damages | Plan around the deadline, not the complaint |
| Lawsuit in the Superior Court | A judge, on evidence from both sides | Yes | Starting the lawsuit is what protects the deadline |
The Internal Appeal
An internal appeal is a creature of the policy. The insurer reviews its own decision, on its own timetable, and there is no tribunal and no independent adjudicator inside the process. Ontario courts have treated an insurer’s appeal process as a question of evidence about what the claimant reasonably understood, rather than as a step that has to be finished before going to court, though some plans impose process conditions of their own. It is worth doing when you have genuinely new evidence that answers the stated reason, and when your deadline is already calculated and in the calendar. It is not worth doing as a substitute for either of those things.
A Complaint to OLHI
The OmbudService for Life and Health Insurance reviews disability complaints free of charge and is independent of the insurers, provided your insurer takes part in it, and its site lists the companies that do. You have to go to the insurer first: OLHI takes a complaint once the insurer has given its final position, or once 90 days have passed with no response. An analyst then gathers information from both sides, an officer may negotiate with the insurer and may make a settlement recommendation, and the aim is to finish within 120 days.
The recommendation is not an order. The insurer can decline it, and nobody at OLHI awards damages. Ontario’s insurance regulator, the Financial Services Regulatory Authority, handles complaints about how an insurance company conducts itself, but it does not decide contract disputes and does not order anyone to pay you.
It fits when the dispute is about how the claim was handled and you want a free review, and not when the money matters and your deadline is close.
A Lawsuit for the Benefits
In Ontario a denied group disability claim is a contract dispute, and it is decided in the Superior Court of Justice. A lawsuit can put things on the table that neither of the other routes can: the benefits you have already missed, an order for benefits going forward or a lump sum in place of them, and damages where the way the insurer handled the claim supports it. Starting a lawsuit does not mean the case is heading for trial, because it can resolve at any point once the evidence has been exchanged.
Paying the Bills While the Claim Is Disputed
A denial creates an income problem long before it creates a legal one. Three sources come up most often, and each has its own test, its own decision-maker and its own deadlines. They also interact with one another, so the order you apply in is worth a few minutes of thought.
EI Sickness Benefits
Employment Insurance sickness benefits run for up to 26 weeks when a medical reason stops you from working. The rate is 55 percent of your insurable earnings, to a maximum of $729 a week in 2026. For many denied claimants this is the bridge that covers the first half year while the disability claim is fought. Be aware that money received now can have to be accounted for later, and what happens when EI benefits have to be repaid is worth understanding before an overpayment letter arrives.
CPP Disability
CPP disability asks a different question, and a harder one. It looks at whether a long-term condition stops you from working at any job on a regular basis and is not expected to improve. Your contribution history matters, and you have to be between 18 and 65. The maximum payment is $1,741.20 a month, and new beneficiaries received an average of $1,234.68 a month as of April 2026.
Because the tests are different and the decision-makers are different, a CPP disability refusal does not decide your insurance claim, and an insurance denial does not decide CPP. Its deadlines are short: a decision can be reconsidered, but the request has to be made within 90 days of receiving the decision letter, and there is a further 90 days to appeal to an independent tribunal after that.
Offsets and Clawbacks
Most group plans reduce the monthly payment by what you receive from CPP disability, and many require you to apply for it. If a CPP disability award later covers months your insurer has already paid for, you can be asked to pay that money back. None of that comes from a statute. It is set out in your plan document, which is one more reason to get the policy in writing rather than assume the booklet tells you the whole story.
Your Job While You Fight the Denial
The disability claim and the employment relationship are two separate questions, and people lose ground on the second one while they concentrate on the first. What you do about your job in the next few months is worth as much attention as the claim file.
Ontario’s Long-Term Illness Leave
Since 19 June 2025, Ontario employees with a serious medical condition have had an unpaid, job-protected leave of up to 27 weeks in a 52-week period. To qualify you need at least 13 consecutive weeks of employment, and a qualified health practitioner has to provide a certificate stating that you have a serious medical condition and setting out the period you will not be working. The leave is unpaid, so it does not solve the income problem. What it does is protect the job while the claim is in dispute, because an employer cannot fire or penalize you for taking it or for planning to take it.
If You Are Terminated While the Claim Is Disputed
A termination during a disability dispute raises its own set of questions, starting with what happens to your group coverage when the employment ends. Coverage and claim are not the same thing, and a claim that was already in progress is not automatically over because the job is. Keep the termination letter, the benefits booklet and any written explanation of what happens to your coverage. Notice and severance are governed by employment law, and how termination rules work in Ontario is a separate question from whether the insurer was right to deny your claim.
Getting Help With a Denied Long-Term Disability Claim
A first conversation about a denied claim is more practical than people expect. It consists of a lawyer reading three documents you can gather this week: the denial letter, the policy or the booklet if that is all you have, and whatever has come back from your request for the file. The first thing we work out is your deadline, because that is the part that cannot be fixed later.
HSK Law acts for disability claimants on a No Win, No Fee basis, the first consultation is free and carries no obligation, and you deal directly with the lawyer handling your file rather than an assistant. We also work with clients in Russian, Punjabi, Vietnamese and Ukrainian. If you want a long-term disability lawyer to look at the letter and the dates, book a free consultation and bring what you have.
Frequently Asked Questions
The general deadline in Ontario is 2 years, and it runs from the day the claim was discovered rather than from the date stamped on the denial letter. Discovery is a question of fact, so the start date is worked out from the documents in your own file: when benefits stopped, what the insurer wrote to you, and what you understood at each stage. On some files the two dates are the same. On others they are months apart, and the difference decides whether a court will hear the case at all.
Not reliably. The insurer’s appeal and the deadline to sue are separate processes, and an appeal is not a safe harbour for the second one. Ontario courts have looked at insurer appeal processes differently depending on what the insurer wrote and when it wrote it, which means no one can promise you that appealing buys time on your particular file. The sensible order is to work out the deadline first and then decide whether an appeal is worth filing, especially where you have genuinely new evidence to send.
Not necessarily. Ontario’s Court of Appeal has held that a group disability policy is not the kind of commercial bargain the law allows to shorten the limitation period, because that coverage serves personal purposes, so the statutory 2 year period applied instead of the 1 year clause in the policy. Wording varies between plans, so the result is not automatic. If an insurer has told you that your time ran out after a year, that is worth having checked before you treat the claim as closed.
Yes. Federal privacy law gives you a right of access to the personal information a business holds about you, and for a disability claimant that reaches the adjuster’s notes, the medical reviews and any surveillance material. Put the request in writing and ask for the complete file rather than a summary. The insurer is expected to respond within 30 calendar days, with up to another 30 days available in specific circumstances if it tells you. It should cost little or nothing, and if material is withheld that should not be, a complaint can go to the Privacy Commissioner of Canada.
Usually yes, and for many people it is the bridge that covers the first months. EI sickness benefits run up to 26 weeks when a medical reason stops you from working, paid at 55 percent of insurable earnings to a maximum of $729 a week in 2026. Two cautions. Money you receive now can be offset or repaid later, depending on what your policy says and on what the insurer eventually pays, and the 26 weeks pass quickly, so the disability claim still has to move while the benefits run.
Applying does not disqualify you from anything, and many group plans require it. The two decisions are made by different people under different tests: CPP disability asks whether a long-term condition stops you from working at any job on a regular basis, while your policy asks whether you meet the definition of disability written into it. A refusal on one does not decide the other. What does change is the money, because most plans reduce the monthly benefit by what CPP disability pays, and a retroactive award can leave you owing the insurer for months it already covered.
Ontario’s long-term illness leave gives eligible employees an unpaid, job-protected leave of up to 27 weeks in a 52-week period, and an employer cannot fire or penalize someone for taking it or planning to take it. Eligibility needs at least 13 consecutive weeks of employment and a certificate from a qualified health practitioner. A denied insurance claim does not remove that protection, because the insurer’s decision and your employment rights come from different places. If your employment is ended during the dispute, keep the letter.
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