How the LTD Internal Appeal Process Works in Ontario
An internal appeal is a request for the insurer to reconsider a denial or termination, usually through the process described in the insurer’s letter or policy materials.
This page explains the mechanics of that process — what to submit, what happens after filing, and how appeal deadlines relate to other dates — not the full decision framework for choosing between appeal and litigation.
Call to discuss your claim: (437) 295-7287
Over a decade of experience practising law in Ontario. A graduate of Osgoode Hall Law School. No fee unless we recover compensation for you. Our fee is up to 33% of the amount recovered, confirmed in writing before we begin work. Virtual consultations across Ontario.
What an internal appeal is — and is not
An internal appeal asks the same insurer to reconsider its decision. It is distinct from litigation, which involves a court or other external process.
An internal appeal is not the only option after a denial or termination. For the full comparison of appeal versus litigation — including when each path may make sense — see the denied LTD claim page.
Internal appeal deadlines versus legal deadlines
An insurer’s letter may state a deadline for submitting an internal appeal. That is the insurer’s stated window for reconsideration under its process.
Separately, a contractual or statutory deadline may affect when legal proceedings can be started. That is a different question.
Do not assume that meeting one deadline controls or extends the other. Check the specific appeal deadline stated in the denial or termination letter, and treat any deadline for starting legal proceedings as a separate issue — addressed further below.
Understanding the insurer’s stated reasons
Before deciding what to submit, identify exactly what the insurer relied on, what it may have misunderstood or not had access to, and what material would directly respond to that specific reasoning.
Resubmitting the original application alone rarely addresses a decision that already reviewed that material. The analytical task is responsive, not repetitive.
What evidence may be submitted
The appropriate submission depends on the specific reason for the decision. Not every appeal requires every category below.
A written appeal letter
A letter that addresses the insurer’s specific stated reasons — not a generic request for reconsideration.
Updated medical evidence
Clinical records or reports that respond to gaps the insurer identified in its decision.
Functional evidence
Material that addresses occupational demands and sustainable work capacity directly.
Vocational or other supporting assessments
Where applicable, assessments that respond to the insurer’s vocational or capacity conclusions.
The existing claim history
The original application, prior medical and vocational evidence, insurer correspondence, and reports the insurer relied upon. A strong appeal often draws on the full file, not only the denial letter.
How to organize and deliver the appeal
Practical organization helps the reviewer see how new material responds to the decision — and protects a clear record of what was sent.
- Use a dated cover submission that explains what you are sending and why.
- Include an organized document index identifying what each new record is intended to address.
- Preserve proof of delivery and a complete copy of everything submitted.
- Avoid sending materials piecemeal without explanation of how they fit together.
What happens after submission
At a high level, the insurer reviews the submission, may request additional information, may schedule a further assessment, and then issues a decision. Exact steps vary by insurer and by the materials submitted.
Who may review the appeal?
Processes vary. The insurer may assign a different claims reviewer, involve internal medical or vocational consultants, or arrange further external assessments, depending on its process.
A different employee reviewing the file does not, by itself, make the appeal independent of the insurer. The decision remains the insurer’s reconsideration of its own position.
Possible outcomes of an internal appeal
Outcomes vary. Nothing below predicts what will happen in a particular claim.
Full reversal
The insurer may reverse its decision and reinstate or approve benefits.
Partial reversal
The insurer may reverse in part — for example, approving benefits for some period but not ongoing entitlement.
Decision upheld
The insurer may uphold its original denial or termination.
Options after an unsuccessful appeal
Other options, including litigation, may still be available, subject to applicable deadlines. The appeal-versus-litigation framework is on the denied LTD claim page. Read the appeal-versus-litigation framework → What an LTD lawsuit involves →
Some insurers offer more than one level of internal reconsideration. The existence of a further internal level does not necessarily mean it must be used before other options are considered.
Does an appeal affect other legal deadlines?
An insurer’s appeal process and the deadline for starting a legal proceeding are not necessarily the same thing. An internal review should not be assumed to pause or extend a legal limitation period. The applicable starting date can depend on the policy, the insurer’s correspondence, the history of the claim, and whether legal proceedings had become an appropriate means of seeking a remedy.
Ontario has a general two-year statutory limitation framework, but that does not mean every LTD claimant has two years from a single universal date such as the initial denial, the termination date, the final internal appeal, or the last benefit payment. The start date can be fact-specific.
A policy may contain contractual timing language. The existence of that language does not by itself establish that it is enforceable, that it applies to a particular claimant’s circumstances, that it displaces the statutory framework, or that an action is late. Defeating a contractual limitation argument also does not necessarily establish entitlement to benefits.
Kassburg v. Sun Life (2014)
In Kassburg v. Sun Life Assurance Company of Canada, 2014 ONCA 922, Sun Life’s appeal was dismissed. On the wording and documents before the Court, a contractual one-year provision was not enforceable. The Court addressed ambiguity in the contractual materials and the application of the Limitations Act’s business-agreement framework. The result was specific to that wording and those circumstances — it does not mean every one-year contractual limitation is unenforceable, or that every group LTD policy receives the same treatment.
Thompson v. Sun Life (2015)
In Thompson v. Sun Life Assurance Company of Canada, 2015 ONCA 162, the Court found that the motion judge had not completed the analysis required before enforcing a contractual one-year provision under the Limitations Act’s business-agreement framework. The claimant’s appeal was nevertheless dismissed on a separate policy-eligibility ground. Thompson is not a claimant victory on the limitation issue, and it does not establish a universal start date for every claim.
Clarke v. Sun Life (2020)
In Clarke v. Sun Life Assurance Co. of Canada, 2020 ONCA 11, Sun Life’s appeal was allowed in part and the summary-judgment determination was set aside. The Court of Appeal did not finally decide that the claim was timely or late. It required a fuller factual record before the appropriate-means component of discoverability — and the possible significance of an informal appeal process — could be resolved. The matter was remitted rather than conclusively decided on the limitation issue.
Issues to avoid
These are practical caution points — not predictions about any one claim.
- Submitting a generic appeal that doesn’t address the insurer’s specific stated reasons.
- Missing the appeal deadline stated in the letter.
- Assuming an appeal automatically preserves the right to sue later. See the warning on legal deadlines.
- Submitting incomplete medical evidence rather than evidence specifically responsive to the insurer’s position.
- Assuming every available internal appeal level must be exhausted before other options can be considered.
What a lawyer reviews
A free case review looks at whether an internal appeal is appropriately framed for the insurer’s stated reasons — and how the appeal window relates to other dates.
- The denial or termination letter and the insurer’s stated reasons
- The full existing claim file and medical/vocational evidence
- What additional evidence would directly respond to the insurer’s position
- The specific appeal deadline that applies
- How that appeal deadline relates to any separate legal deadline
For the shared appeal-versus-litigation framework, see the denied LTD claim page. If benefits were previously approved and then stopped, see the terminated benefits page. Back to the LTD claims guide →
Insurer-specific guidance
When insurer pages are published, they will appear here.
Frequently asked questions
- How long do I have to file an internal appeal?
- Check the deadline stated in the denial or termination letter and any policy materials the insurer points to. That period varies by insurer and policy. It is a different question from any deadline for starting legal proceedings.
- Can I appeal more than once?
- Some insurers offer more than one level of internal reconsideration. Whether a further internal level exists, and whether using it is required before other options are considered, depends on the insurer’s process and the circumstances of the claim.
- Are there costs involved in preparing an LTD appeal?
- Insurers typically do not charge a filing fee to submit an internal appeal. Claimants may still incur costs for medical reports, records, assessments, or legal advice when preparing a submission. Those preparation costs are separate from any insurer filing fee.
- What if my appeal is denied?
- An unsuccessful internal appeal does not automatically end every option. Other paths, including litigation, may still be available subject to applicable deadlines. See the denied LTD claim page for the appeal-versus-litigation framework.
- Should I get a lawyer involved before submitting an appeal, or only if it’s denied?
- Either timing can make sense depending on the file. Early review can help identify which evidence responds to the insurer’s stated reasons and how the appeal deadline relates to other dates. Waiting until after a denial may leave less room to organize a responsive submission.
- Can I submit new evidence during an appeal that I didn’t have before?
- Appeals often include updated or additional evidence that responds to the insurer’s stated reasons. What is useful depends on the gaps or misunderstandings in the decision — not every appeal needs every category of new material.
Sources & citations
- Limitations Act, 2002 — Limitations Act, 2002, S.O. 2002, c. 24, Sched. B, ss. 4, 5, 15 and 22 (basic limitation period, discoverability, ultimate limitation, and agreements). View source
General Ontario statutory framework. Application to a particular LTD file is fact-specific.
- Kassburg v. Sun Life Assurance Company of Canada — 2014 ONCA 922 (Court of Appeal for Ontario). Appeal and cross-appeal dismissed; contractual one-year provision not enforceable on the wording and documents before the Court; ambiguity and s. 22 business-agreement analysis addressed. View source
Does not establish current insurer forms or a universal contractual rule.
- Thompson v. Sun Life Assurance Company of Canada — 2015 ONCA 162 (Court of Appeal for Ontario). Appeal dismissed; motion judge had not completed the s. 22 analysis required to enforce a contractual one-year provision; appeal dismissed on a separate policy-eligibility ground. View source
Not a claimant victory on limitation; not a universal start-date rule.
- Clarke v. Sun Life Assurance Co. of Canada — 2020 ONCA 11 (Court of Appeal for Ontario). Appeal allowed in part; summary-judgment determination set aside; fuller factual record required for appropriate-means discoverability and the informal appeal process; remitted rather than finally decided on limitation. View source
Does not mean an informal appeal always suspends a limitation period.
- Contingency fee disclosure — No fee unless we recover compensation for you. Our fee is up to 33% of the amount recovered, confirmed in writing before we begin work. A written contingency fee agreement is required under Ontario rules before work begins.
Related reading
- LTD claims guideA plain-language guide to how long-term disability claims work in Ontario — group and individual policies, own-occupation and any-occupation periods, denials, terminations, and when legal advice may help.
- Denied LTD claimA denial letter is not the final word. Next steps depend on the reason given.
- Terminated benefitsBenefits may stop after a review, surveillance, return-to-work assessment, or definition change.
- Change of definitionMany Ontario LTD policies shift disability definitions around the 24-month mark — timing depends on the policy.
- LTD lawsuitWhat litigation against an LTD insurer actually involves — steps, evidence, costs, and timelines.
- FeesLearn how contingency fees, a free case review and disbursements work for Ontario long-term disability claims. Our fee is up to 33% of the amount recovered.
- AboutLearn about Ontario Long-Term Disability Lawyers, our insurer-side experience and how our legal team helps with denied or terminated disability benefits across Ontario.