Common Reasons for Long Term Disability Denials

Applying for long term disability (LTD) benefits can be a lifeline for individuals who are unable to work due to serious medical conditions. However, disability claim denials are quite common, often leaving claimants confused, frustrated, and financially and emotionally burdened.

In Ontario and across Canada, long term disability claims are frequently denied for a variety of reasons, ranging from insufficient medical evidence to procedural errors.

Understanding the most common reasons for disability denial can help you avoid missteps, better prepare your documentation, and strengthen your case for a successful appeal process.

Why Do Long Term Disability Claims Get Denied?

Disability insurance companies often deny LTD claims based on strict interpretations of policy language and rigid documentation requirements. Even when the claimant’s condition is legitimate, a denial letter may arrive citing technicalities or perceived gaps in your medical documentation.

Below is a breakdown of the key reasons LTD claims are denied, organized into categories for clarity.

Common Reasons for Disability Insurance Claim Denials

Insufficient Medical Evidence

One of the most common reasons for denial is a lack of comprehensive medical documentation. Insurance providers require consistent, objective evidence proving the severity of your condition and how it impairs your ability to work. If your physician’s notes are vague, lack detail, or do not clearly link your symptoms to functional limitations, your claim may be rejected. Additionally, if you fail to follow up with specialists or do not adhere to recommended treatment plans, insurers may argue that your condition is not as serious as claimed.

When it comes to LTD denials, a lack of comprehensive documentation is one of the most common reasons. Insurance providers look for:

• A clear diagnosis from a specialist
• Evidence of ongoing symptoms and functional impairments
• A documented treatment plan
• Medical reports showing how your condition affects your ability to perform essential duties

If your file lacks any of these, the claim denial may state “insufficient medical evidence”.

Lack of Objective Medical Documentation:

Insurers often prefer complete objective proof (e.g., MRIs, S-rays) over self-reported symptoms. This also includes:

• Lan results
• Scans and imaging reports
• Clinical assessments
• Physical or cognitive function tests

If your doctor’s notes rely primarily on your description of how you feel, the insurer may view the evidence as unreliable.

Incomplete or Inaccurate Information:

Failing to provide a complete medical history or leaving out critical details, such as past treatments, medication use, or functional limitations, can significantly harm your case and lead to a denial.

Insufficient Support from Your Own Doctor:

If your doctor’s opinion lacks clarity, detail, or fails to specifically outline how your condition impacts your ability to perform job duties, your claim may be denied.

Failure to Provide Timely Claim Notification

LTD policies contain specific definitions of “disability”, which may change over time. For instance, a policy may define disability initially as the inability to perform you “own occupation”, but after a certain period, it may shift to an “any occupation” standard; meaning you must be unable to perform ANY job for which you are reasonably qualified. If the insurance company believes you can perform some type of work, even if it pays significantly less or is unrelated to your career, your claim could be denied.

• Most disability insurance policies include strict timelines for notifying the insurer of your condition and submitting documentation.
• Incomplete forms or delayed responses to requested information can jeopardize your claim.

Your Condition Isn’t Covered or Doesn’t Meet the Policy’s Definition of Disability

Each insurance policy defines “disability” differently. In some cases, your medical condition may not meet the criteria, even if it severely impacts your life.

“Own Occupation” vs. “Any Occupation”

Most LTD policies initially cover your inability to perform your own occupation, but after a certain period (usually within two years), you must prove you can not do any occupation for which you’re reasonably qualified.

Not “Totally Disabled”

If the insurer believes you can still perform certain job duties, even part-time, they may deny benefits.

Policy Exclusions

Disability insurance policies may exclude pre existing conditions, mental health conditions, or injuries related to specific occupations or activities.

The Insurer Disputes the Severity of Your Condition

Even if you have submitted medical evidence, the insurance company may argue that your condition isn’t severe enough to qualify for long term disability benefits.

• The insurer may rely on their own doctor’s opinion or an Independent Medical Examinations (IME) to dispute your diagnosis.
• In some cases, insurers may argue that you’ve failed to follow prescribed treatments or that your reported limitations do not match your medical records.

Discrepancies in the Evidence

Inconsistent statements, conflicting medical records, or gaps in your medical history can raise red flags for insurers. For example:

• Your doctor’s report says you cannot walk more than a few minutes, but your social media shows vacation photos of you hiking.
• Your Independent Medical Examinations (IME) report contradicts your own physician’s diagnosis.

Such discrepancies can seriously harm your claim, even if they are due to procedural errors or misunderstandings.

Adverse Social Media Information

Insurance companies and private investigators often monitor claimants’ social media activity as part of their efforts to validate or dispute a long term disability claim. If you’re receiving disability benefits but post photos or videos suggesting physical activity, travel, participation in social events, the insurer may interpret this as evidence that you are not “totally disabled” or that your condition has improved enough to resume work.

Be cautious with:

• Facebook, Instagram, TikTok posts
• Online comments about your activities
• Public check-ins at restaurants, gyms, or entertainment venues
• Photos or videos shared by friends and family that tag or mention you

Even seemingly harmless content, such as smiling in a photo, attending a family gathering, or walking you dog, can be taken out of content. Investigators may not consider that these moments are exceptions to your typical day or that you pushed yourself through pain to attend short events.

Social media surveillance is increasingly used to paint a narrative that contradicts medical claims, especially when content is publicly accessible. To protect your claim, consider limiting you social media use, adjusting privacy settings, and reminding friends not to tag or post about you without permission during your claim period.

Why Hire an LTD Lawyer When Your Disability Claim Is Denied

If you’ve received a denial letter, you’re not alone, and you are not out of options. Hiring a disability lawyer can significantly improve your chances of a successful appeal or lawsuit.

A disability lawyer can help you:

• Review your denial and determine the real reason behind it
• Gather additional evidence and request independent assessments
• Ensure you meet all strict timelines for appeals
• Represent you during negotiations or legal proceedings
• Help you avoid missteps in the appeals process

If your long term disability claim was denied, it’s essential to understand why. Common causes includes insufficient medical documentation, missed deadlines, discrepancies in the evidence, and policy exclusions. Don’t let a complex system or a powerful insurance company discourage you; every claimant deserves a fair evaluation.

Grillo Law offers a free consultation to review your case and help you understand your rights. If your disability insurance claim was denied, we’re here to support you through the legal process and help you seek the benefits you deserve. With deep knowledge of disability insurance policies, help you gather comprehensive documentation, and advance on your behalf. Contact us today for your free consultation and take the first step towards protecting your future.