WHY LONG-TERM DISABILITY CLAIMS GET DENIED IN ONTARIO
Most LTD denials aren't decisions about whether you're unwell. They're decisions about whether the file answers the question the policy actually asks.
What the adjudicator is checking
An adjudicator isn't reading your story. They're scoring your function against a fixed set of benchmarks, and against the real physical and cognitive demands of your actual job.
The Basics — Activities of Daily Living
Clothes on and off, including fasteners and shoes.
Washing yourself in a tub or shower, unassisted.
On, off, and hygiene — on your own.
In and out of a bed or chair. Canes and walkers are fine; needing another person is not.
Getting prepared food from plate to mouth.
Bladder and bowel control, or managing it yourself.
How your file is graded against the physical requirements of your job.
Where your job sits on the strength scale — desk work through heavy lifting.
Fine hand and finger work: typing, tools, small parts.
Anything specific to your role — driving, climbing, standing all shift.
The same movement, over and over, across a full workday.
Sustaining the physical pace for a full shift, day after day.
Mental health files are graded on function too — socialization, ability to make decisions, memory / focus, and cognitive endurance.
Interacting with coworkers, customers, and supervisors.
Judgment, adaptation, and handling the normal pressures of the role.
Concentration, recall, and staying on task.
Mental energy and motivation sustained across a full workday.
What your practitioner has to actually write
The single most common gap I saw on the desk was a doctor writing something completely accurate that wasn't in the language the file is graded in. "Unable to work" is a conclusion. An adjudicator needs the findings underneath it — what you can't lift, for how long, how often, and what happens when you try. Specific, measurable, and tied to the demands of your role.
What kills the file
A conclusion with no measurable findings underneath it.
The adjudicator cannot translate a diagnosis or a statement that you are unable to work into functional limits for you.
Restrictions described in general terms rather than against your actual job demands.
If the file never connects your limits to the work your role requires, the policy test remains unanswered.
A gap in treatment with no explanation anywhere in the file.
Without context, a lapse can be read as evidence that the condition was not severe enough to require ongoing care.
A mental-health claim documented only in narrative, with nothing addressing socialization, decision-making, memory and focus, or cognitive endurance.
The narrative can be completely true and still leave the functional test the adjudicator must apply unanswered.
Evidence built for the own-occupation test and never rebuilt for the any-occupation test at month 24.
Evidence that supported your inability to perform one role does not necessarily answer whether you can perform another suitable occupation.