Should You File a Legal Claim or Internal Appeal for Long-Term Disability in Ontario?

As a recently disabled Ontario worker, you’re going through a time of life characterized by immense uncertainty and struggle. Accustomed for all of your adult life to feeling independent and “in charge”, you’re finding it incredibly difficult to depend on others for help. Despite it all, you “took the bull by the horns”. 

As you worked through the enormously challenging process of gathering the information needed to file the claim, you came to understand that , ironically, qualifying for long-term disability benefits would not depend so much on which specific physical or mental conditions were detailed in the reports, or on whether you are now unable to do your job. The decision to start giving you benefits was going to depend on whether or not you would be able, “for the foreseeable future”, to perform the duties at any job for which you are reasonably suited.

Having swallowed (and that was not easy, to be sure) those awful truths, you followed the many, many steps needed to gather the information required for filing a Long-Term Disability claim. You took extra care to meet every deadline, struggling to survive financially on the short-term disability benefits that fall so far below the level of income to which you were accustomed.

Now, following weeks of filling out paperwork, of seemingly endless visits and correspondence with different medical professionals, of telephone interviews and unwelcome visits to your home by strangers —you’ve been informed that your claim has been denied…

Know this – you’re hardly alone

While no official statistics have been published showing the precise percentage of long-term disability income claims that are denied, truth is that more than half of applicants receive denial letters every year. Both government agencies and insurance companies feel the need to cut costs, counting on the fact that many people who’ve suffered debilitating injuries and illnesses will simply “give up” and not persist in claiming the benefits they deserve.

In addition, certain types of long-term disability are harder to “prove” than others. While mental illness is one of the most prevalent causes of disability its impact is often misunderstood, the Income Security Advisory Centre states. Some physical disorders such as chronic pain disorders, fibromyalgia, and certain autoimmune diseases are also difficult to “prove”.

Study the letter, determining the “who” and the “what”:

The “who” – Which agency or insurance company sent you the letter denying your claim for disability benefits in Ontario, Canada?

1. The Canada Disability Benefit, a program administered by Service Canada
2. The Ontario Disability Support Program (ODSP),
3. An insurance company

The “what” – What, exactly, did the denial letter say was the reason for the decision to deny you benefits?

• They say you are not “totally disabled”
• They say you haven’t provided a sufficient amount of medical evidence
• They called one of your doctors for clarification and did not get a response
• Your income from sources other than your job is too high
• You own property or other assets that they believe should be used towards your support before you request assistance
• You don’t have enough recent work history
• They claim you were not forthright with examiners
• Your social media posts show you are capable of more activity than your claim implies

The denial letter has set the legal clock ticking:

The moment you received that denial letter, the clock began ticking, limiting the time in which you have the right to file an internal appeal. (The typical deadline for appeals falls between 60 and 180 days).

Meanwhile, in Ontario, the standard limitation period for a lawsuit against an insurance company that has denied long-term disability benefits is two years from the date of denial.

Internal Appeal vs. Legal Claim. What’s the difference?

You opened your letter and saw it: Denied.

Now you’re stuck between two paths (appeal or sue) with different deadlines and very different leverage.

Here’s how to choose the right move without losing time, evidence, or your right to a fair recovery.