Most long-term disability denials turn on a change in the policy definition of disability, usually at the two year mark, from being unable to do your own occupation to being unable to do any occupation you are reasonably suited to.
The two year switch
Most policies change the test after roughly two years. Up to that point you qualify if you cannot do your own job. After it, you have to be unable to do any occupation you are reasonably suited to by education, training or experience.
Terminations cluster around that date because the test changed, not because anything about your condition did.
The other common reasons
A paper review by a consultant who never examined you. A gap in treatment, which insurers read as evidence of recovery. Surveillance. Or an allegation about something in the original application.
Each of those has a known answer, and the answer depends on which one you are actually facing. The denial letter usually says.
Read the policy, not the letter
The letter tells you what the insurer decided. The policy tells you what they had to establish. The distance between those two documents is where the case lives.
Ask for the full policy wording and the claim file, including internal notes and the instructions given to any assessor.
Appeal or sue
Internal appeals are free and sometimes work. They also consume time, and the limitation period continues running while you wait.
Whether to appeal or issue a claim should be a decision made with the deadline in view, not a default.
Deadlines that apply to you
These are the dates that end claims. Check them first.
In most Ontario claims you have two years from the day you knew, or ought to have known, that you had a claim.
Limitations Act, 2002, S.O. 2002, c. 24, Sched. B, s. 4
Questions we get every week
Almost certainly because the policy definition changed from own occupation to any occupation. That is a contract term doing the work.
Generally two years, though when the clock starts can be argued about and is not always the date on the denial letter. Do not assume you are out of time without checking.
Yes. A gap in treatment is one of the most common grounds relied on, and continuing care is also the evidence that supports the claim.
Where this applies
Long-Term Disability
Most long-term disability denials in Ontario are not about whether you are ill.
Read moreInsurance Disputes
Ontario insurers owe policyholders a duty of good faith in how they handle a claim.
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A traumatic brain injury can be severe and permanent while every scan comes back normal.
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