When a Disability Insurer Says You Can Work: What Happens After an LTD Claim Is Denied?

October 16, 2026, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

You paid for disability insurance.

You expected it to be there if you ever became seriously ill or injured and could no longer work.

Then you make a claim.

And the insurer says:

“We don't believe you're disabled.”

Or perhaps you've been receiving benefits, and the insurer suddenly decides you are capable of returning to work.

For someone already dealing with a serious health problem or injury, that decision can be overwhelming.

It can also create an immediate financial crisis.

What does “disabled” actually mean?

One of the most important things to understand is that disability insurance policies have their own definitions of disability.

The question isn't necessarily whether you are completely unable to do anything.

Depending on the wording of your policy, the test may initially focus on whether your condition prevents you from performing the essential duties of your own occupation.

After a specified period—often two years—the definition may change.

Your policy may then require you to demonstrate that you are unable to perform the essential duties of any occupation for which you are reasonably suited by education, training or experience.

This change can be a major turning point in an LTD claim.

Why would an insurer deny a legitimate disability claim?

Insurers assess claims using medical information, policy wording and other evidence.

A denial may involve questions about:

• Your medical diagnosis
• The severity of your symptoms
• Functional limitations
• Your ability to perform your job
• Treatment and prognosis
• Pre-existing conditions
• Whether you have complied with treatment
• Whether another occupation may be suitable

Sometimes an insurer concludes that the medical evidence does not support the level of disability being claimed.

That doesn't necessarily mean the insurer's conclusion is correct.

“But I can do some things.”

This is one of the most common misunderstandings about disability.

Being able to perform some activities does not necessarily mean that you are capable of maintaining employment.

For example, someone with a serious back injury might be able to walk around their home for short periods but be unable to sit at a desk for eight hours.

Someone with post-concussion symptoms might be able to have a conversation with a friend but be unable to concentrate sufficiently to perform their professional responsibilities.

The relevant question is often functional capacity, not whether a person can perform occasional activities.

What if your benefits are terminated after you've already been receiving them?

This can be particularly difficult.

You may have structured your household finances around your LTD benefits.

Then an insurer reassesses your claim and decides that you can return to work.

Your monthly benefit stops.

Your mortgage, utilities and other expenses don't.

A termination of benefits should not simply be accepted without understanding the basis for the decision and the terms of your policy.

The policy wording matters

Disability insurance policies are contracts.

The precise language matters.

Two people with similar medical conditions can potentially have different legal outcomes because their policies contain different definitions, exclusions or limitations.

That's why an LTD dispute cannot be assessed solely by looking at the medical diagnosis.

The policy itself needs to be carefully reviewed.

What evidence can strengthen an LTD claim?

Medical evidence is important, but it isn't the only evidence that may matter.

Depending on the circumstances, useful evidence can include:

• Medical records
• Specialist reports
• Functional assessments
• Occupational therapy assessments
• Employer records
• Job descriptions
• Performance records
• Treatment history
• Medication records
• Documentation of functional limitations

It is particularly important that medical evidence explains how your condition affects your ability to perform the actual requirements of your occupation.

A diagnosis alone may not tell the whole story.

What should you do if your LTD claim is denied?

Don't assume that a denial means the end of your claim.

1. Start by obtaining the insurer's decision and understanding why the claim was denied.
2. Review the applicable policy.
3. Gather relevant medical and employment documentation.
4. Most importantly, call us and get legal advice before making significant decisions about your claim.

There may be deadlines that apply to legal action, and the applicable limitation period can depend on the circumstances and the wording of the policy.

You bought the coverage for a reason

Disability insurance is supposed to provide financial protection when illness or injury prevents you from working.

If an insurer denies or terminates your benefits, the issue isn't simply whether you agree with the decision.

The question is whether the decision is supported by the evidence and the terms of the insurance policy.

If you are dealing with a denied or terminated long-term disability claim in Ontario, Deutschmann de Koning Law can help you understand your legal options.

The firm represents individuals dealing with disability insurance disputes throughout Kitchener-Waterloo, Cambridge, Guelph, Woodstock and Southwestern Ontario.

This article provides general information about long-term disability insurance claims in Ontario and is not legal advice. Disability policies vary, and the rights of an insured person depend on the specific policy wording and circumstances of the claim.

About Deutschmann de Koning Law

Deutschmann de Koning Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann and Nick de Koning focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.ddinjurylaw.com or call us at 1-519-742-7774.