What are common reasons Private / group long-term disability (LTD) insurance claims are denied?

Definition of disability not met under your policy wording Pre-existing condition exclusion Surveillance or social media inconsistent with reported limits Missing attending physician updates during the elimination period

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Private insurance

Private / group long-term disability (LTD) insurance

Income replacement from a private or employer group policy after short-term benefits end. Definitions of disability, waiting periods, and offsets vary by contract.

Typical timeline: Elimination periods often range from 90–180 days; insurer decisions can take additional weeks once files are complete.

This page is a dedicated, search-friendly version of the same checklist on the main disability benefits guide. Progress checkboxes sync in your browser only.

Claim checklist & evidence

Forms

Plan-specific claim kit — Employee statement + attending physician forms from the insurer

Step-by-step

1. Notify the insurer early if you may be off work long term
Some policies have strict notice clauses.
Next: Ask for the exact forms your plan administrator requires.
2. Understand how EI or CPP decisions interact with LTD offsets
Many policies reduce payment when other income replacement is payable.
Next: Keep copies of all insurer letters and calculation explanations.

Evidence to gather

Check off items as you collect them — progress is saved only on this device (same keys as the main benefits guide).

Summary plan description or policy booklet for your coverage — Defines own occupation vs. any occupation tests and offsets.
Objective hand function findings (grip, pinch, sensibility) when available — Insurers often want measurable impairment beyond pain reports.

Common reasons claims get denied

Definition of disability not met under your policy wording
Pre-existing condition exclusion
Surveillance or social media inconsistent with reported limits
Missing attending physician updates during the elimination period

Sources

Financial Consumer Agency of Canada — insurance basics · accessed 2026-04-24