If your long-term disability (LTD) claim has been denied or terminated, your first instinct may be to fire off an angry email, but you would do well to resist that urge. A strong appeal letter should be focused, evidence-driven, and clearly anchored to your policy’s definition of disability. Below is a practical, lawyer-approved guide to help you write an appeal that actually gives the insurer a reason to change its decision. 

It is important to note that internal appeals are usually optional. In many provinces (including BC), strict limitation periods can keep running from the date of denial. Don’t let appeals eat up your right to sue. If you’re unsure, get legal advice early.

Step 1: Get Your Long-Term Disability Documents in Order

Before you start drafting your appeal letter you should look at your:

1. Denial/termination letter: Highlight every stated reason for denial and any deadlines.
2. Policy/benefits booklet: Find the definition of disability, “own-occupation” vs. “any-occupation” test, pre-existing condition clause, proof of loss rules, offsets, and appeal procedures.
3. Complete claim file: Ask your insurer in writing for your entire file including internal notes, medical reviews, surveillance, vocational reports, and policy excerpts relied upon.
4. Job description/duties: Get your actual duties (not just a generic title). Outline any cognitive, physical, attendance, and safety-critical demands.
5. Medical evidence: Get treating physician notes and a focused functional letter, relevant assessments (neuropsychological testing, FCE, imaging/labs), medication side-effects, therapy progress documentation, as well as evidence of anticipated investigations and procedures and likely wait times.

Step 2: Build the Story Around the LTD Policy Test

Insurers deny claims because they say you don’t meet the test(s) laid out in your policy. Your appeal should map your limitations to that test, not just recite diagnoses. For example, for most policies you need at first to be disabled from your Own-Occupation, often for the first 24 months of disability. If you are applying in your Own-Occupation period you should explain why you cannot perform the material and substantial duties of your job, reliably and safely and on a predictable schedule. Or, if you are applying for disability under the Any-Occupation period, where you need to prove you are disabled from any occupation you are reasonably suited for, you will need to show why no reasonable occupation fits your education, training, experience and income level given your restrictions. 

Step 3: Address Each LTD Denial Reason Head-On

You need to address every reason you were denied disability benefits. If your insurer says there was insufficient objective evidence, you need to point to testing that correlates with function (e.g., processing speed deficits tied to accuracy requirements, FCE showing poor endurance/recovery). If such testing hasn’t been done, explain what’s pending and when. If your insurer says you can do sedentary work, clarify your real duties (decision density, documentation pace, client/safety obligations, etc.). Reliability over time and not being able to perform a one-off task is the standard.

If the denial is based on policy language you need to ensure you understand that language to properly respond. If you are denied due to a pre-existing condition, look at the time frame and treatment criteria in your policy. Distinguish a prior, stable condition from the new disabling episode. Or if your denial is based on alleged non-compliance with the policy, document reasonable treatment efforts, side-effects, and barriers (waitlists, cost, contraindications, etc.).

Make sure you address the reasons for denial directly and unambiguously.

Step 4: Long-Term Disability Documents: Tone, Structure, and Proof

The tone of your appeal letter matters. Be professional, concise, and respectful. Do not go on rants and do not bring up issues that do not directly relate to the reasons for the denial and the basis for your appeal.

Make sure your appeal letter has a clear and clean layout. Have clear headings and sections. Make sure you have a point-by-point rebuttal of the denial(s). Numbered pages can be helpful if the appeal documentation is voluminous. If you refer to clinical records in your appeal letter, make sure it’s clear where and what you are referring to.

You will need proof to support your appeal. It is helpful to attach a short evidence index to help cross-referencing in your appeal letter (e.g., “See Attachment 3, Dr. Singh letter, p.2”). The better organized and clear your information is presented the better you will be able to communicate the basis of your appeal.

Step 5: What to Ask Your Doctor(s) to Write In Your LTD Claim

One of the most important things required to support an appeal is a letter from your doctor(s) that supports your disability.

A useful medical letter focuses on your function and refers back to the definition of disabled as it is laid out in your policy. You’ll want a diagnosis and a review of your medical history, but more importantly have your doctor(s) lay out specific restrictions/limitations (e.g., “cannot sustain concentration beyond 15-20 minutes without error; requires recumbent rest twice daily”). Then have them provide the medical rationale linking symptoms and side-effects to job duties. This, with a clear prognosis and treatment plan (including wait-times) can be extremely helpful in appealing a denial.

It can also be good to have them add a statement on your reliability regarding medical attendance and why trial work or proposed accommodations are not presently feasible.

When to Stop Appealing and File an Insurance Claim Denial Lawsuit

While it would be great if every appeal was successful, the reality is sometimes you cannot change an insurance company’s mind. Some things that are a clear signal it may be time to move towards a lawsuit is if the insurer is recycling the same reasons without engaging with your new evidence. If your insurance file contains a biased paper review or unreasonable “any-occupation” positions detached from your background and earnings, this can also be a signal that it is time to skip the internal appeal and move to litigation. However, the most important signal that it is time to get a lawyer is that you are approaching your limitation deadline. When this is can depend on your policy language, but once you miss your limitation deadline, even a lawyer can’t help you.

Experienced Long-Term Disability Denial Lawyers 

The lawyers at Taylor & Blair LLP act for claimants across British Columbia and Canada in LTD appeals and litigation. If your claim was denied or terminated, we can review your policy, build the right medical-legal record, and advise whether to appeal, sue, or both. Initial consultations are free, and most LTD files proceed on contingency (no legal fees unless we recover).

If you’ve been wrongfully denied your long-term disability benefits contact us for a free consultation today.