Overview
Long-Term Disability Claims in British Columbia
Long-term disability (LTD) insurance provides crucial income replacement when illness or injury prevents you from working. Whether obtained through your employer or purchased privately, your LTD policy represents a contractual promise to provide benefits when you become disabled. Unfortunately, insurance companies frequently deny valid claims, terminate benefits prematurely, or interpret policy terms in ways that unfairly exclude coverage. Our litigation team has extensive experience challenging these denials and securing the benefits our clients deserve.
LTD policies typically have two distinct benefit periods: an "own occupation" period (usually the first two years) during which you qualify if unable to perform your specific job, followed by an "any occupation" period where the test becomes whether you can perform any job for which you are reasonably suited by education, training, or experience. Many claim denials occur at this transition point, with insurers arguing claimants can work at some alternative occupation despite ongoing disabilities.
Common reasons insurers deny or terminate LTD claims include disputing the severity or existence of the disability, relying on biased independent medical examinations (IMEs), surveillance showing activity inconsistent with claimed restrictions, pre-existing condition exclusions, failure to provide requested information, and mental health or chronic pain conditions that are difficult to prove objectively. Understanding why your claim was denied is the first step toward successful appeal or litigation.
When insurers wrongfully deny or terminate claims, claimants may be entitled not only to past and future benefits but also to additional damages for the insurer's bad faith conduct. In cases where insurers act unreasonably in handling claims, courts have awarded aggravated and punitive damages reflecting the vulnerability of disability claimants and the power imbalance with insurers. Our lawyers pursue all available remedies to maximize recovery for our clients.
Our LTD Claim Services
- Appeals of initial LTD claim denials with comprehensive medical evidence
- Challenging "own occupation" to "any occupation" terminations
- Disputing biased independent medical examination (IME) conclusions
- Challenging surveillance-based claim terminations
- Fighting pre-existing condition exclusion denials
- CPP disability offset and integration disputes
- Policy interpretation and coverage disputes
- Bad faith claims against insurers for unreasonable conduct
- Reinstatement of benefits after wrongful termination
- Return-to-work and rehabilitation disputes
Our LTD Claim Process
Policy & denial review
We thoroughly analyze your policy terms, the insurer's denial reasons, and your complete medical history to identify the strongest grounds for challenging the denial.
Medical evidence development
We work with your treating physicians and, where necessary, independent medical experts to build compelling evidence supporting your disability claim.
Internal appeal
Where policy terms require, we pursue internal appeals with the insurer, presenting additional evidence and legal arguments to overturn the denial.
Demand & negotiation
We issue formal demands to the insurer outlining the basis for your claim and our evidence, often achieving settlement without the need for court proceedings.
Litigation
If settlement cannot be achieved, we commence legal proceedings seeking past and future benefits plus additional damages for any bad faith conduct by the insurer.
FAQs About LTD Claim Denials
What are the most common reasons for LTD claim denials?
Common denial reasons include insufficient medical evidence of disability, disputes over the severity of conditions (especially chronic pain or mental health issues), pre-existing condition exclusions, failure to meet the "any occupation" test after the initial benefit period, discrepancies between claimed restrictions and observed activities, and failure to follow treatment recommendations. Understanding the specific basis for your denial guides our strategy.
Can I appeal if my LTD claim was denied?
Yes. Most policies provide for internal appeals within the insurance company, and you always have the right to pursue legal action in court. The appeal process allows you to submit additional medical evidence and arguments. Whether to appeal internally or proceed directly to litigation depends on your specific circumstances, the denial reasons, and the policy terms. We advise on the best approach for your situation.
What damages can I recover if my claim was wrongfully denied?
You can recover past benefits that should have been paid, ongoing future benefits until age 65 or policy expiry, and interest on unpaid amounts. In cases of bad faith—where the insurer acted unreasonably or in breach of their duty of good faith—you may also recover aggravated damages for mental distress and, in egregious cases, punitive damages to punish the insurer's conduct.
What is the limitation period for LTD claims in BC?
The limitation period is generally two years from the denial or termination of benefits under BC's Limitation Act. However, ongoing benefit claims may have different considerations, and some policies contain limitation clauses that may be shorter. Given the complexity, we recommend seeking legal advice promptly after any denial to ensure your rights are protected.
Does receiving CPP disability benefits help my LTD claim?
CPP disability approval provides helpful evidence that the federal government has found you disabled, though LTD insurers are not bound by that decision. Note that most LTD policies offset CPP benefits against LTD payments, so receiving CPP typically reduces your LTD payment dollar-for-dollar. Insurers often require you to apply for CPP disability and may recover overpayments if CPP is awarded retroactively.