Getting a letter from your insurer denying or cutting off your long-term disability (LTD) benefits can feel like the end of the road. It isn’t. Denials and terminations are common, and in many cases they can be challenged successfully — most effectively with legal advice guiding the next step.
This article walks through the difference between a denial and a termination, the most common reasons insurers give for cutting off benefits, why certain conditions face extra scrutiny, and what steps you can take to protect your claim.
What Is the Difference Between a Denied and Terminated LTD Claim?
A denied claim is one that never gets approved in the first place. You apply for LTD benefits, submit medical evidence, and the insurer decides — often after an initial review — that you don’t qualify.
A terminated claim is different: your benefits were approved and you were receiving payments, but the insurer later decides to stop them. Termination often happens around the point where the policy’s definition of disability changes from “own occupation” to “any occupation” — typically at the two-year mark — but it can also happen well before or after that point if the insurer decides your medical evidence no longer supports ongoing disability.
The distinction matters because it affects your evidentiary starting point. With a denial, you’re often building a case from scratch. With a termination, there is already a history of the insurer having accepted that you met the policy’s disability test. That history can be important when examining why the insurer later concluded that you were no longer entitled to benefits. Both scenarios also share something important: the clock on your legal deadlines keeps running regardless of what internal process the insurer offers you.
Why Long-Term Disability Claims Get Denied or Terminated
Insurers cite a range of reasons when denying or cutting off LTD benefits. The most common include:
Insufficient medical evidence. Vague or incomplete reports from treating physicians can leave gaps the insurer is quick to exploit.
Missing or incomplete paperwork. Claim forms, functional capacity information, or updated medical documentation submitted late or incompletely can trigger a denial on technical grounds alone.
Not meeting the policy’s definition of disability. This is especially common when a policy shifts from an “own occupation” to an “any occupation” standard. A claimant who can no longer perform the material duties of their own occupation may still face an argument from the insurer that they are capable of another occupation that meets the requirements of the policy, taking into account factors such as their education, training, experience and, depending on the policy wording, potential earnings.
Failure to follow treatment recommendations. Insurers may argue that a claimant hasn’t pursued recommended treatment, and use that to suggest the disability isn’t as severe as claimed — even where the treatment wasn’t accessible, affordable, or medically appropriate.
Pre-existing condition issues. Many policies contain pre-existing condition clauses that exclude or limit coverage for conditions that existed before the policy took effect.
Missed deadlines or appeal windows. LTD claims can involve several different deadlines, including deadlines for submitting claim information, insurer appeal deadlines, and legal limitation periods. These are not necessarily the same thing. Missing an insurer’s internal appeal deadline does not automatically mean that you have lost the right to pursue legal action, but failing to act within an applicable legal limitation period can have serious consequences.
Surveillance, social media, or insurer investigations. Insurers sometimes conduct physical surveillance or review claimants’ social media activity, then use isolated moments — a good day, a family event — to argue against the reported level of impairment.
Insurer-arranged medical assessments. Independent medical examinations (IMEs) and other insurer-arranged assessments are sometimes used to generate a conclusion that conflicts with a claimant’s own treating specialists.
Why Mental Health and Chronic Pain Claims Are Often Challenged
Some conditions face a harder road with insurers simply because they don’t show up on an X-ray or a blood test. Chronic pain, mental health conditions like depression and anxiety, fibromyalgia, and post-concussion symptoms all fall into this category.
The absence of objective testing does not mean the absence of disability. Conditions such as chronic pain, fibromyalgia and many mental health conditions can cause significant functional impairment even where imaging, bloodwork or other testing does not provide a simple objective measure of severity. What matters is how the condition affects the claimant’s ability to function. Consistent symptom reporting, a coherent treatment history, and evidence documenting functional limitations can all support a valid LTD claim.
What to Do If Your LTD Claim Is Denied or Cut Off
- Read the denial letter carefully. The letter should explain the insurer’s specific reasons for denying or cutting off your benefits.
- Note any deadlines. Both internal appeal deadlines and the broader limitation period for legal action matter here — and they don’t run on the same clock.
- Review the insurer’s reasons. Understanding exactly what the insurer relied on shapes what happens next.
- Gather supporting medical records. Updated reports, functional assessments, and documentation addressing the insurer’s stated concerns.
- Talk to a lawyer before deciding whether to appeal. An internal appeal may feel like the more familiar first step, but it’s handled entirely by the insurer, on the insurer’s timeline, and it does not pause the limitation period for suing. Getting legal advice before you commit to that process — rather than after it stalls or fails — puts you in a stronger position from the start.
Why an Internal Appeal Isn’t Always the Right First Move
Insurers design their internal appeal process, run it, and decide its outcome. It can feel like the natural next step after a denial or termination, but it comes with real limitations:
- The insurer remains the decision-maker. The same organization that denied or cut off your claim is the one reviewing your appeal — often using much of the same reasoning.
- It doesn’t pause your legal deadlines. The limitation period for taking legal action keeps running while an appeal is pending. Claimants who wait for an appeal decision before seeking legal advice sometimes find their window for a lawsuit has narrowed significantly.
- It can delay stronger options. Time spent on an appeal that was unlikely to succeed is time not spent building a legal case.
This doesn’t mean an appeal is never appropriate — but that decision is best made with legal advice, not as an automatic first response to a denial letter.
How a Long-Term Disability Lawyer Can Help
- Review the denial or termination letter to understand exactly what the insurer relied on and identify weaknesses in its reasoning.
- Review the LTD policy itself, including the applicable definition of disability, exclusions, offsets, and any change-of-definition provisions.
- Assess whether an internal appeal is even worthwhile, or whether legal action is the stronger path given the insurer’s reasoning and your timeline.
- Examine the medical and functional evidence to identify gaps and determine what additional evidence may strengthen the claim.
- Work with treating physicians and specialists to develop evidence that addresses not simply the diagnosis, but how the condition affects your ability to function and work.
- Communicate with the insurer on your behalf, shifting the dynamic away from a claimant negotiating alone against an insurer’s process.
- Protect your legal deadlines so that time isn’t lost to an internal process that may not lead anywhere.
Conclusion
A denial or termination letter is not the final word on your LTD claim — but how you respond matters. Rather than automatically defaulting to the insurer’s own internal appeal process, an important first step is to speak with a lawyer who can assess your situation, protect your deadlines, and determine the strongest path forward.
If your long-term disability claim has been denied or your benefits have been terminated, Kotak Law can review the insurer’s decision, explain your options, and help determine the best way forward. We represent disability claimants on a contingency-fee basis, meaning there are no legal fees unless we recover compensation for you.
Frequently Asked Questions
What’s the difference between a denied and a terminated LTD claim? A denial means your claim was never approved — the insurer decided from the outset that you didn’t qualify. A termination means you were already receiving benefits and the insurer later stopped them, often around the shift from an own-occupation to an any-occupation definition of disability.
Should I go through my insurer’s internal appeal process first? Not necessarily. The internal appeal is run entirely by the insurer, and it doesn’t pause the limitation period for legal action. In many cases, speaking with a lawyer before starting an appeal — rather than after it stalls — leads to a stronger outcome.
Does an internal appeal pause the deadline to sue my insurer? No. The limitation period keeps running throughout the appeal process. This is one of the most common and costly misunderstandings claimants have, and it’s a key reason to get legal advice early rather than waiting on an appeal decision.
Can I still win my claim if my condition doesn’t show up on medical tests? Yes. Conditions like chronic pain, depression, anxiety, and fibromyalgia often lack objective test results, but LTD claims have never required that kind of proof. Consistent symptom reporting, a coherent treatment history, and documented functional limitations can support a valid claim.
Will insurer surveillance or my social media automatically defeat my claim? Not on its own. Insurers sometimes use isolated moments — a good day, a family photo — to argue against a claimant’s reported limitations, but this kind of evidence is often taken out of context and can be challenged.
What should I do first after receiving a denial or termination letter? Read the letter carefully to understand the insurer’s stated reasons, note every deadline mentioned, and speak with a lawyer as early as possible — before an appeal deadline or limitation period narrows your options.
Do I need a lawyer to appeal an LTD denial or termination? It’s strongly recommended. A lawyer can determine whether an internal appeal is worth pursuing at all, or whether legal action is the stronger route from the outset — a decision that’s difficult to make well without legal advice.
About the Author
Nainesh Kotak
Founder of Kotak Personal Injury Law
Canadian Long-Term Disability Lawyer
Nainesh Kotak is the founder of Kotak Personal Injury Law and a leading Canadian long-term disability lawyer recognized by the Canadian Lexpert Directory. Called to the Bar in Ontario, Alberta and British Columbia, he has more than 30 years of legal experience and represents individuals in disability insurance disputes involving mental health conditions, chronic pain, cancer and other serious illnesses and injuries. Nainesh is Vice President of the Ontario Trial Lawyers Association and a former Chair of OTLA’s Long Term Disability Section. He is also a frequent legal commentator in Canadian media.
