What to do next
Get the policy and the denial reason in writing
Request the full policy or group master policy — not just the booklet — and the specific provision relied on. The definition of disability is the pivotal wording, and 'own occupation' versus 'any occupation' changes everything.
Address the stated ground with evidence
Where the insurer says the evidence is insufficient, get specialist reports addressing functional capacity specifically — what you cannot do, for how long, and why. Diagnosis alone rarely decides an LTD claim; function does.
Watch the limitation period, not just the appeal
Internal appeals can be worth using, but they do not pause the limitation period, and policies often shorten it contractually. Get legal advice on the deadline before spending months appealing.
Frequently asked questions
Should I use the insurer's internal appeal?
It can work and costs nothing, but it does not extend your limitation period. Find out your deadline first, then decide.
What does 'own occupation' mean?
That you are disabled if you cannot do your own job. Many policies switch to 'any occupation' after a period, which is a much harder test — check when yours changes.
Can they deny a mental health claim?
Mental health conditions are covered by most policies, though some limit the benefit period for them. Denials often turn on objective evidence of functional limitation, which is what treatment records must address.
How are LTD lawyers paid?
Frequently on contingency. Ask about the percentage, disbursements, and what happens if the claim fails, in writing.
This is general information, not legal advice. Laws vary by location and every situation is different — speak with a qualified lawyer about your specific circumstances.