RBC LTD Denial? How to Push Back with the Right Evidence (Ontario)

The letter you received from your Royal Bank of Canada insurance company came as a terrible shock. Unable to work for the past two years, struggling to keep your spirits up in the face of the total upheaval of your once so-active lifestyle, you had been taking comfort in knowing that the regular monthly benefit check was enough to cover at least your basic living expenses. Now, you’ve learned, in just a couple of months, those checks will no longer be arriving.

The RBC Company has informed you that your benefits are being terminated at the 24-month mark. The reasoning — “insufficient evidence of total disability”. For the first two years, they are saying, since you were “unable to perform the essential tasks of your pre-disability employment”, you qualified for benefits. However, they say, beginning with month #25, you must be able to prove that you cannot perform the duties of “any occupation for which you’re suited based on your education, training, and experience.”  

You’ve endured months and months of treatments, tests, and interviews, cooperating with your case manager, enduring surveillance and lack of privacy, all the while struggling  to keep your spirits up in the face of an inability to sleep, the chronic pain, the anxiety attacks. How ironic it is, while RBC seems to imply that you’re being lazy, avoiding a return to the workforce, truth is — you long for the day you can once again be active and productive.

Instead, you feel overwhelmed — how can you push back against this cruel denial of the financial benefits you need to sustain you while you fight to regain health and strength?

If RBC denies or stops your Ontario LTD, capture deadlines, collect your policy and denial letter, pinpoint the stated reason, and choose between an internal appeal or a legal claim. Strengthen functional-limitations evidence with your doctors, avoid treatment gaps, and consider legal advice on timelines and costs.

Why RBC Denied Your LTD Claim

What are the most common reasons RBC denies or terminates LTD?

• “Insufficient functional evidence” (your records list symptoms, but not work limits).
• “Not totally disabled” (RBC says you can do sedentary or alternate work).
• Non-compliance (missed forms, missed appointments, or treatment gaps).
• File review or IME conflicts (insurer doctor disagrees with your treating doctors).
• Surveillance or social media misinterpretation.
• 24-month change from “own occupation” to “any occupation.”

Start by pinpointing 3 elements in the LTD denial letter:  

• Deadlines for filing an appeal or a lawsuit

As you reread the denial letter issued by RBC, take careful note of the two specific deadlines the company is giving you for taking action.

1. Deadline for filing an “internal appeal” (usually 60-180 days)
2. Deadline for filing suit against the company (usually two years)

• Reasons for the denial
  

Reasons often cited by Ontario LTD insurance companies for discontinuing benefits at the 24-month mark include:

1. There hasn’t been enough objective evidence showing you are unable to work in “any occupation” suited to someone with your training and education. 
2. They say you have not followed the treatment plan recommended by your doctors and therapists.
3. Surveillance (interviews with neighbors and proprietors of places where you are a customer, plus things you’ve shared on your social media sites) contradict your claim of total disability.
4. Your insurance policy from RBC required you to apply for government benefits such as the Canada Pension Plan Disability and you failed to do that. 
5. You had failed to disclose the fact that you own property or other assets that might have been used towards your support.

• Recommendations for further testing

Notice whether, in the letter, any new tests and evaluations are being recommended, and whether you will be expected to pay part or all of the cost. One or both of two categories of evaluation might be mentioned:

1. Tests to determining what kinds of jobs might be appropriate –and available — for someone with your experience and training whose physical and mental capacity is now diminished  (the letter might mention a CEA (Competitive Employability Assessment) or a TSA (Transferable Skills Analysis).
2. Tests to determine whether the treatment plan prescribed by your own doctors was suitable (the letter might mention an IME (Independent Medical Examination) or an FCL (Functional Capacity Limitations test). 

Internal appeal or lawsuit — what’s the dif? Weighing the pros and cons:

• The differences:

Appeal:

An internal appeal challenges the insurance company’s decision to terminate your benefits.  While you are responding to the concerns mentioned in the denial letter, offering new evidence of both your disability and your efforts to comply with the treatment plan, you are still leaving the decision up to RBC’s employees and hired consultants.

Lawsuit:

When you choose to start a lawsuit, you are turning to a third party, letting the court system decide whether you qualify for continued benefits. The insurance company will be forced to obey whatever the court’s decision is, or agree to a settlement.

• Pros and cons:
  

1. The appeal process is generally faster than a lawsuit.
2. The appeal process is less formal — and can be less confrontational than a lawsuit.
3. There are no court fees involved in an internal appeal.
4. Filing an internal appeal is generally a faster, less formal, and less confrontational a process, and can be effective if supplying missing documentation helps resolve any issues.
5. At the same time, relying on an internal appeal risks missing the deadline for filing a lawsuit.