Denied Long-Term Disability in BC

Next step

• Appeals overview: https://timlouislaw.com/ltd-appeals-vancouver/
• Learn more: https://timlouislaw.com/long-term-disability-lawyer-vancouver-bc/
• Mental-health denials: https://timlouislaw.com/long-term-disability-for-depression-ptsd-or-anxiety/
• Contact Tim Louis & Company: https://timlouislaw.com/contact-us/

Common denial reasons, in plain English

“J., a bookkeeper from Surrey, called with a fresh denial that said ‘insufficient evidence.’ We didn’t send a 20-page bundle. We asked her GP for a one-page letter tied to her real job tasks, corrected two IME facts by page number, and added three recent clinic notes. Three weeks later, the insurer reversed.”
That is the model. Short. Specific. On point.

“Insufficient medical evidence.”
This usually means the file is thin or the letters are vague. Ask your doctor for a one-page note that names the diagnosis, lists functional limits, and ties those limits to your actual job duties. Add recent clinic notes or tests that show change over time.

“Not totally disabled from own occupation” or “any occupation.”
Function, not labels, decides this. Map your limits to real tasks: sitting tolerance, keyboarding, reach, concentration, reliability. For “any occupation,” add training, education, and experience, and whether the work is realistic for you. If the insurer used the wrong job profile, say so in writing.

“Pre-existing condition clause.”
Insurers point to a look-back window before coverage began. Check the exact dates and what was actually treated in that window. Many denials overreach. Ask for the policy clause, the window dates, and the records relied on. Get a clinician letter that separates old, stable symptoms from the condition that now disables you. If the clause is being misapplied, we can push back.

“Non-compliance” with treatment or rehab.
You’re expected to try reasonable treatment. You’re not required to try everything. Document side effects, contraindications, wait-lists, and failed trials. If a program is unsafe or unrealistic, propose an alternative your doctor supports and put that in writing.

“Surveillance contradicts your claim.”
Short clips hide breaks, help from others, and next-day fallout. Ask for all footage, the dates, and the investigator’s report. Write a same-day note with context: duration, assistance, flare. Ask your provider to restate your restrictions in plain English.

From Tim: “If you remember three things, make them these: put every deadline in your calendar, ask for your file in writing, and keep your doctor’s letter tied to your real job tasks. The rest we can sort together.”

Evidence that moves the needle

Insurers decide on paper. Strong, focused proof changes results. Here is what actually helps.

A doctor letter that answers the insurer’s exact questions

Ask your provider for a one-page letter that does four things:

1. names the diagnosis and duration,
2. lists objective findings and observed signs,
3. sets out restrictions and tolerances in simple numbers, and
4. explains why those limits stop you from doing your job’s key tasks.

Keep it concrete: “can sit 20 minutes, then needs 5 minutes standing; typing 10 minutes at a time; off-task 20 percent most days; two to three bad days a week.” Avoid vague lines like “try to increase activity.” Add recent clinic notes or tests that show change over time.

Functional limits in real-life terms

Translate symptoms into function the insurer can measure. Tie limits to duties: lifting, typing, standing, attention, pace, and reliability. Note what happens after activity: pain spikes, migraines, brain fog, nausea, next-day crash. For mental health claims, capture focus, memory, panic triggers, social tolerance, and time needed to recover after appointments or stressors.

Example: “Cashier. Must stand most of the shift, handle money accurately, and interact pleasantly. Patient can stand 15 minutes before pain, needs frequent position changes, and loses focus after 20 minutes despite medication. Errors increase late morning. Would miss 3 to 4 days per month.”

IME rebuttals and factual corrections

If an IME is wrong, correct it fast and in writing. List each error with the page and line. Attach a short supporting record for each point. Ask your GP or specialist for a brief note that addresses the key mistakes and restates your restrictions in plain English. Keep the tone steady. One page often beats ten.

Useful targets: wrong job description, tests not performed, symptoms minimised, surveillance misread, history misstated, or conclusions that ignore documented flares.

Symptom diary, workplace history, and vocational notes

A two-to-four-week diary shows patterns that a single “good day” can’t. Log start times, activities, breaks, help from others, and the aftermath. Add workplace history: written job description, performance reviews, accommodation attempts, HR emails, and incident reports. If you have OT or vocational notes, include a clear list of essential duties and why those duties aren’t feasible with your limits.

 “M., a chef, kept a two-week diary showing short prep bursts, repeated sit-stand changes, and a pain crash after a trial shift. Paired with a one-page surgeon letter and a page-and-line IME correction, the insurer reinstated benefits.”

Condition-specific help

Depression, PTSD, anxiety
Denials often say “insufficient evidence” or focus on diagnosis labels instead of function. We tie symptoms to reliability, focus, sleep, and attendance, and ask your providers for short, targeted letters.
https://timlouislaw.com/long-term-disability-for-depression-ptsd-or-anxiety/

Chronic pain
Pain is variable. We document pacing, flare patterns, and recovery time in real numbers, then link those limits to the physical and cognitive demands of your job.
https://timlouislaw.com/chronic-pain-disability-claims/

Chronic fatigue syndrome
Post-exertional malaise, brain fog, and non-restorative sleep are the core issues. We build a function-first record that explains why even low-exertion work is not reliable.
https://timlouislaw.com/long-term-disability-lawyer-vancouver-bc/chronic-fatigue/

Fibromyalgia
Outdated expectations about “tender points” still appear in files. We focus on sleep disruption, cognitive load, and documented activity limits that affect real job tasks.
https://timlouislaw.com/fibromyalgia-and-long-term-disability-claims/

IBS
Unpredictability is the disability. We show how urgent washroom access, pain, and fatigue undermine attendance and productivity, even with accommodations.
https://timlouislaw.com/ibs-long-term-disability-claims-2/

Autoimmune diseases
Flares and remission cycles confuse decision-makers. We chart severity over time, medication effects, infection risk, and why consistent work is not realistic.
https://timlouislaw.com/autoimmune-disease/

Cancer
Treatment side effects, fatigue, neuropathy, and infection risk need clear documentation tied to your duties. We gather concise letters from oncology and family medicine.
https://timlouislaw.com/cancer-and-long-term-disability-in-canada/

Heart disease and stroke
Limits often involve stamina, safety, and cognition. We connect objective testing and rehab notes to job-critical tasks and reliability.
https://timlouislaw.com/heart-disease-stroke-and-long-term-disability-claims/

Vision and hearing loss
We address safety, accuracy, and communication demands, plus failed accommodation attempts, to show why essential duties cannot be met.
https://timlouislaw.com/vision-and-hearing-loss/

Lyme disease
Episodic symptoms require a clear function diary and focused clinician support. We present consistency and recovery time, not just labels.
https://timlouislaw.com/lyme-disease-long-term-disability/

Multiple sclerosis
Fatigue, heat sensitivity, relapses, and cognitive change are central. We tie these to error rates, pace, and absenteeism in your role.
https://timlouislaw.com/multiple-sclerosis-and-long-term-disability-claims/

Parkinson’s disease
Tremor, rigidity, and on–off medication periods affect fine motor work, pace, and safety. We translate this into concrete work limits.
https://timlouislaw.com/parkinsons-disease/

Self-employed claimants
You wear many hats. We separate essential duties, prove income history, and address policy quirks that trip up entrepreneurs.
https://timlouislaw.com/disability-lawyer-for-self-employed-bc/

The 24-month review

Most group policies start with an own occupation test. You are disabled if you cannot do the main duties of your job. Around month 24, many policies switch to any occupation. Now the question is whether you can do any work that fits your training, education, and experience and that is realistic for your health.

Prepare early.
Start six months before the switch. Ask the insurer, in writing, for the review schedule, the policy definition of “any occupation,” and what reports they will rely on. Book a focused visit with your doctor and request a short letter that addresses the new test: which types of work you could not do, for how long, and why. Tie limits to reliability, pace, attention, and stamina, not just diagnosis.

Tackle the job issue.
If the insurer suggests a job that is not realistic, say why in concrete terms. For example, “receptionist” may require sustained attention, public interaction, and accurate keyboarding you cannot maintain. Ask for the labour market or vocational report they used and correct any wrong assumptions about skills, training, or earnings.

Mind the timing.
The month-24 review often triggers new assessments or surveillance. Keep your routine honest, attend reasonable exams, and respond in writing. If the review is close and the evidence is thin, call a lawyer before the switch so deadlines and wording are handled properly.

Quick cue from Tim: “If you do just one thing, ask for the policy’s ‘any occupation’ definition in writing and put the review date in your calendar today.”

What not to do after a denial

Do not miss dates.
Deadlines end cases. Put every date in your calendar and keep the envelope for the postmark.

Do not send long emotional letters.
Insurers decide on evidence. Keep your reply short and focused. Answer their reasons with specific medical and functional proof.

Do not stop treatment.
Gaps in care are used against you. If a treatment is unsafe or ineffective, document the reason and work with your doctor on an alternative.

Do not post without context.
Old photos look new. Short clips hide breaks and next-day fallout. Keep profiles private and add context if you must post.

A few more quiet rules that save claims: do not ignore phone calls, reply in writing; do not sign open-ended releases; do not attend an IME unprepared; do not return to work without a plan from your doctor.