Denied Long-Term Disability Benefits? 5 Things to Do Before You Appeal (Ontario)

The letter you received from your RBC Insurance company came as a terrible shock. Although you understood from the beginning that, at the 24-month mark, your long-term disability benefits would be reviewed, you believed it was obvious to both the medical professionals treating you and the insurance company representatives checking up on you that, despite your hopes of getting your life back, you are still far from able to return to work.

The letter talks of insufficient medical evidence and demands that you undergo an “independent medical exam”, or IME, with a doctor of their choosing. At the same time as offering you the right to appeal their decision to stop paying benefits, they are demanding yet another vocational assessment.

What is particularly discouraging is that you have never missed a doctor’s appointment. While struggling with puzzling and painful symptoms, you have never failed to follow the recommendations of your therapists. If the insurance company experts cannot see that, what hope is there to change their minds with an appeal?

If your long-term disability benefits were denied in Ontario, do not rush into an appeal before reviewing the denial letter, your policy, and the evidence the insurer used against you. First, calendar every deadline, identify the exact reason for the denial, request your claim file, gather medical and work-related evidence, and consider speaking with an Ontario LTD lawyer before sending anything back to the insurance company. A rushed appeal can create inconsistencies or use up valuable time while the legal deadline to sue continues to run.

Why Appealing Fast Can Backfire

Rushing to accept your Ontario LTD insurer’s offer to file an appeal can prove to be a costly mistake. Under pressure to meet the deadline, you may unintentionally lock in a story containing inconsistencies the company can use against you later.

You may cite the reports from your doctors and therapists, but the insurer’s denial may focus on function and reliability in the workplace, not on diagnosis alone.

You also have a strict limitation period to file a lawsuit. An internal appeal, reviewed by the same company that denied your benefits, can use up valuable time while that legal deadline continues to run.

The Denial Letter Is a Roadmap If You Read It the Right Way

What to Highlight: A Quick Checklist

• The precise denial reasons stated in the letter
• The definition of disability being applied, such as own occupation or any occupation
• Any mention of paper reviews, insurer doctors, IMEs, assessments, vocational testing, job matching, or surveillance
• The appeal steps and deadline window

Common Denial Language

• “Insufficient evidence”
• “Not totally disabled”
• “Sedentary work”
• “Expected improvement”
• “Non-compliance”
• “Pre-existing condition limitation”

The Five Things to Do Before You Appeal

1. Calendar All Deadlines and Protect Your Timeline

• Put every deadline in your calendar, including appeal windows, forms, and assessment dates.
• Create a simple timeline: symptoms, treatment, work impact, claim, and denial.
• Start a claim folder for letters, forms, medical records, notes, and emails.

2. Identify the Real Reason You Were Denied

Most denials fall into three buckets:

• The evidence does not prove disability.
• The insurer says you have capacity for work.
• Policy exclusions or limitations apply.
• Write the denial reasons as bullet points in your own words.
• Note what is missing, such as function detail, consistency, specialist input, or work proof.

3. Request the Documents the Insurer Relied On

You cannot respond well if you do not know what the insurer used against you.

Request the following in writing:

• The policy booklet and disability definition
• Internal medical consultant reports, including paper reviews
• IME reports, if any
• Vocational assessments or transferable skills analyses
• Surveillance summaries, if referenced
• A list of all documents in the claim file

Practical Tip: Keep communication in writing and save PDFs.

4. Build Evidence That Targets Function and Reliability

Use the four proof buckets framework:

• Medical proof: diagnosis, treatment, and prognosis
• Functional proof: restrictions and limitations tied to job tasks
• Reliability proof: bad days, flare patterns, recovery time, and stamina
• Work proof: job demands, accommodations, and failed return-to-work attempts

Ask your doctor to document:

• Specific restrictions and limitations, not only the word “disabled”
• Frequency and duration of symptoms and flares
• Cognitive impacts, if relevant, including focus, processing speed, and errors
• Ability to sustain work 8 hours a day, 5 days a week, or why that is not realistic
• Treatment plan and expected course

Add credibility with simple supporting records:

• Job description and real duties
• Attendance record
• Accommodation attempts
• Medication list and side effects
• Symptom and reliability log, simple and consistent

5. Choose the Safest Path: Appeal First or Get Legal Advice First

Your choice depends on:

• Deadline pressure
• Complexity of your medical condition
• Whether the insurer relied on an IME or paper review
• Any occupation timing, often near 24 months
• Surveillance or vocational issues

An internal appeal may be reasonable in some cases, but you should understand the risks first, especially when there are tight deadlines, an adverse IME, surveillance, vocational suitable work arguments, or complex and variable conditions.