Receiving a long-term disability (LTD) denial can feel devastating — especially when you are already living with a condition that makes working impossible. If your claim was denied or delayed, you are not alone. Insurers reject a significant number of legitimate claims, and certain types of disabilities face far higher denial rates than others.
Understanding which disabilities are hardest to get approved for — and why — can help you prepare a stronger application, respond to an insurer’s pushback, or decide whether you need legal support. This guide explains the landscape of difficult LTD claims in plain language so you can take your next step with confidence.
Whether you are filing for the first time or fighting a denial, our team at UL Lawyers can help you navigate your long-term disability claim. You may also want to use our long-term disability benefits calculator to get a sense of what you may be entitled to under your policy.
Table of Contents
- What Is the Hardest Disability to Get Approved For?
- What Is the Hardest Disability to Prove?
- Why Do Insurers Deny So Many Mental Health and Chronic Pain Claims?
- What Should You Do if Your LTD Claim Is Denied?
- How Long Does It Take to Get LTD Benefits Approved in Ontario?
What Is the Hardest Disability to Get Approved For?
No single disability is automatically denied, but certain conditions are routinely flagged for heightened scrutiny — or outright rejection — by Canadian insurers. The hardest disabilities to get LTD approved for tend to share one key trait: they rely heavily on subjective reporting and are difficult to confirm through standard objective tests.
The Most Commonly Denied Conditions
- Mental health conditions — Depression, anxiety disorders, PTSD, and bipolar disorder are among the most frequently denied LTD claims. Insurers often argue these conditions are “self-reported” and question their severity or duration.
- Chronic pain disorders — Fibromyalgia, complex regional pain syndrome (CRPS), and chronic widespread pain are notoriously difficult to approve because there is no definitive blood test or imaging scan that “proves” the pain.
- Chronic fatigue syndrome (ME/CFS) — This condition is widely misunderstood, and insurers frequently argue that claimants can perform some work, even when fatigue is debilitating.
- Chronic back and spine conditions — While structural damage can sometimes be seen on imaging, the functional impact — how much pain actually limits you — is frequently disputed.
- Addiction and substance use disorders — Many LTD policies contain exclusions or time limits for these conditions, and the stigma around addiction can lead to unfair treatment.
- Lupus and autoimmune diseases — Symptom flares make consistent medical documentation challenging, and insurers may point to “good days” as evidence that a claimant is not truly disabled.
- Concussion and traumatic brain injury (TBI) — Cognitive symptoms like memory loss and brain fog are hard to quantify, and neuropsychological assessments are sometimes disputed by insurer-hired experts.
Why Do Insurers Deny These Claims?
Insurers rely on independent medical examinations (IMEs), surveillance, and policy language to challenge difficult claims. Under most Canadian group LTD policies — governed by your province’s Insurance Act and the policy contract itself — you must prove you cannot perform the duties of your own occupation (own-occ definition) or, after a transition period, any occupation (any-occ definition). Conditions without clear objective markers make that proof harder to assemble without skilled legal or medical help.
The Ontario e-Laws database is a useful resource for understanding the statutory framework that applies to insurance contracts in this province.
What Is the Hardest Disability to Prove?
Being approved for LTD and proving your disability are closely linked, but they are not identical challenges. A claim can be hard to prove even when the medical community fully accepts the condition as real and serious. The difficulty lies in translating your lived experience into the medical-legal evidence an insurer or court requires.
Conditions That Are Especially Hard to Prove
1. Mental health and psychiatric conditions Disorders like major depressive disorder, generalized anxiety disorder, and PTSD do not show up on an MRI or blood panel. Proof rests on psychiatrist or psychologist reports, functional capacity evaluations, and consistent treatment records. Insurers frequently hire their own psychiatrists to contest the severity of your symptoms.
2. Fibromyalgia and chronic pain Fibromyalgia is recognized by the medical community as a legitimate condition, but its hallmark — widespread musculoskeletal pain — cannot be confirmed by a single definitive test. Proving it means building a longitudinal medical record that documents consistent symptoms, treatment attempts, and functional limitations over time.
3. ME/Chronic fatigue syndrome Post-exertional malaise — the worsening of symptoms after minimal effort — is the defining feature of ME/CFS, but it is invisible to an outside observer. Wearable monitoring data, actimetry records, and specialist reports from a physician experienced with ME/CFS can all help, but the evidentiary burden remains high.
4. Invisible neurological symptoms Cognitive impairment from conditions like multiple sclerosis, post-COVID syndrome, or concussion can be severe but intermittent. Neuropsychological testing, occupational therapy functional assessments, and detailed physician notes are critical to building a provable record.
How to Build a Stronger Proof Package
- See your treating physicians regularly and describe every symptom, including how it affects your ability to work and perform daily tasks.
- Keep a symptom journal — consistent self-recorded data can corroborate your medical team’s findings.
- Request detailed functional capacity reports, not just diagnoses. An insurer needs to see what you cannot do, not just what is wrong with you.
- Avoid gaps in treatment — insurers treat treatment gaps as evidence that your condition is not as serious as claimed.
- Consult a disability lawyer early — legal counsel can identify the evidentiary gaps in your file before you submit or appeal.
The Law Society of Ontario can help you verify that any lawyer advising you on your LTD claim is a licensed, regulated professional.
Why Do Insurers Deny So Many Mental Health and Chronic Pain Claims?
Mental health conditions and chronic pain disorders together account for a disproportionate share of LTD denials in Canada. Understanding the insurer’s playbook can help you anticipate and counter common denial strategies.
Common Denial Tactics
- “Insufficient objective evidence” — Insurers demand imaging, lab results, or other objective markers that these conditions simply do not produce.
- Policy-based mental/nervous limitations clauses — Many group LTD policies cap mental health benefits at 24 months, after which coverage ends unless the condition has a co-occurring physical diagnosis. Reviewing your policy language carefully — or having a lawyer review it — is essential.
- Surveillance and social media monitoring — Insurers may conduct video surveillance or review your social media to find moments that appear inconsistent with your claimed disability.
- IME reports — Insurer-commissioned independent medical examiners sometimes spend as little as an hour with a claimant before producing a report that contradicts years of your treating physician’s records.
Your Rights Under the Ontario Human Rights Code
Disability is a protected ground under the Ontario Human Rights Code. While the Code primarily governs workplace accommodation rather than insurance contracts, its recognition of mental health conditions and chronic illness as legitimate disabilities reinforces why denials based purely on “subjectivity” are increasingly being challenged — and overturned — through litigation and negotiation.
If your employer is involved in the denial (for example, through a group benefits plan), human rights protections may apply in parallel to your LTD claim.
What Should You Do if Your LTD Claim Is Denied?
A denial letter is not the end of the road. Most LTD policies provide a formal internal appeal process, and if that fails, you may have the right to pursue litigation in Ontario’s courts. Here is a general roadmap:
Step-by-Step After a Denial
- Read the denial letter carefully. Note the specific reason given — this shapes your appeal strategy.
- Check your limitation period. In Ontario, a two-year limitation period generally applies to LTD claims under the Limitations Act, 2002, but your policy may impose shorter contractual deadlines. Missing a deadline can permanently bar your claim.
- Gather updated medical evidence. New specialist reports, functional assessments, or clinical notes that address the insurer’s stated reasons for denial can be powerful on appeal.
- File an internal appeal. Submit a written appeal with supporting documentation before any policy deadline.
- Consult a disability lawyer before accepting any settlement. Insurers sometimes offer lump-sum settlements that are far below the true value of your claim.
- Consider litigation if the appeal fails. Ontario courts have consistently held insurers to a duty of good faith, and bad-faith denials can attract additional damages.
Our long-term disability legal team has experience guiding clients through every stage of this process, from initial applications to trial.
How Long Does It Take to Get LTD Benefits Approved in Ontario?
Timelines vary widely depending on the insurer, the complexity of your condition, and whether your claim is denied and appealed. Here is a general picture:
- Initial decision: Most insurers are contractually required to respond within 30 to 90 days of a completed application, though delays are common.
- Elimination (waiting) period: Before LTD kicks in, you must typically exhaust a short-term disability or waiting period of 90 to 180 days. LTD benefits begin after this.
- Internal appeal: An insurer’s internal appeal review can take an additional 60 to 120 days.
- Litigation: If your claim proceeds to court, resolution through settlement or trial can take one to three years or longer, depending on complexity.
The sooner you seek legal advice, the better positioned you are to preserve your rights and evidence. Use our long-term disability benefits calculator to get a preliminary estimate of the monthly benefit amount that may be at stake in your specific situation.
Talk to a UL Lawyers Team Member
If you are facing an LTD denial or struggling to get a difficult disability claim approved, you do not have to fight the insurer alone. Contact UL Lawyers for a free, no-obligation consultation — our disability law team serves clients in Burlington, across the GTA, and throughout Ontario, and we can review your policy, your denial letter, and your options at no upfront cost to you.