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Group and individual disability insurance claims and terminations
Long-term disability denials
You paid for this coverage for years. The denial letter is a negotiating position, not a verdict.
Disability claims are denied and terminated on a small number of predictable grounds: the definition of disability changing from "own occupation" to "any occupation" at the two-year mark, alleged insufficient objective evidence, surveillance, and pre-existing condition exclusions. Each has a well-established answer. The critical detail is whether your plan is governed by contract, by a collective agreement, or by federal or provincial employment legislation, because that determines whether you sue, arbitrate, or appeal internally — and choosing wrong can waste a year.
The forks in the road
What actually changes who should hold this file
Each of these moves the file to a different set of practitioners. All of them are in our intake.
Union membership
If your benefits flow from a collective agreement, a court may have no jurisdiction at all and the matter belongs in labour arbitration. This is a threshold question many general firms get wrong.
The change-of-definition date
Most group policies redefine disability at twenty-four months. A file built for the first definition and not rebuilt for the second gets terminated on schedule.
Mental health or chronic pain as the basis
Insurers treat these claims differently and litigate them differently. Firms that handle them well are a distinct group.
Whether you have appealed internally
Internal appeals feel productive and frequently just consume limitation time while adding nothing. Sometimes they help. Knowing which is which is the expertise.
Simultaneous CPP-D, EI sickness or workers’ compensation claims
These interact, offset and occasionally contradict each other. Handled together they reinforce; handled separately they undermine.
The first weeks
What competent counsel does early
Not what they say in a consultation — what actually happens in the file while you are still recovering.
- Obtaining the full policy wording and the complete claim file from the insurer, which you are generally entitled to and which most people never request.
- Identifying the limitation period, which in disability cases can run from an early denial rather than the final one.
- Aligning the treating physicians’ reporting with the actual policy definition instead of generic notes.
A denial is common and reversible far more often than people assume. But if you can genuinely perform the substantial duties of your occupation, no lawyer can change that, and an honest one will say so at the first call.
Get this in front of someone who does it every week.
Ten minutes of intake, one name back, no cost and no obligation.
Long-term disability denials by province
The limitation clock and the notice traps are provincial. Pick where it happened.
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