What to Do if Your Employer's Insurer Denies Your Claim
You've been off work due to illness or injury. You filled out all the forms, submitted your doctor's note, and waited for your short-term or long-term disability (LTD) benefits to be approved. Then, instead of financial relief, you receive a letter from the insurer: 'Your claim has been denied.'
For most Albertans, that denial comes as a shock. You've paid into your group benefits plan for years — but when you finally need it, your employer's insurer says no.
As Alberta disability lawyers who once defended insurance companies, we know how group insurers handle these claims, what their denial letters really mean, and how to overturn them.
This article explains why employer-sponsored disability claims are denied, what to do next, and how a lawyer can help you recover the benefits you've earned.
Common Insurance Challenges in Alberta
Employer-sponsored insurers deny claims more often than most people realize.
Typical reasons include:
Why Employer-Based Disability Claims Are Often Denied
Employer-sponsored plans are managed by insurers who profit from minimizing payouts. Even genuine disabilities are frequently questioned.
Step-by-Step: What to Do After a Denial
A denial doesn't mean your claim is over — it just means the insurer needs to be challenged properly.
Read the Denial Letter Carefully
Identify the insurer's stated reason for denial and note any appeal deadlines. Keep the envelope or email for your records.
Request Your Complete Claim File
You're entitled to every document the insurer used to make its decision — medical opinions, internal notes, and consultant reports.
Talk to Your Doctor
Show them the denial letter. Ask them to clarify or expand their medical opinion, especially regarding functional limits and prognosis.
Gather Missing Evidence
This may include: Updated medical reports or imaging, Functional Capacity Evaluation (FCE), Psychological or pain-clinic assessments.
Don't Rely Solely on Internal Appeals
Insurer 'appeals' are handled by the same company that denied you. Success rates are low.
Contact an Alberta Disability Lawyer
We can review your policy, assess the denial, and either negotiate reinstatement or file a lawsuit under Alberta's Insurance Act.
How a Lawyer Strengthens Your Case
Legal representation shifts the power dynamic with insurers.
Review Your Entire Policy
To identify overlooked coverage clauses.
Coordinate Independent Assessments
To fill medical gaps.
Challenge Biased Insurer Doctors
With evidence-based rebuttals.
Calculate Back Pay and Future Benefits
Ensuring you receive full compensation.
Negotiate Settlements or File Suit
Under Alberta's Insurance Act.
Case Example
A 38-year-old Edmonton nurse was denied LTD after the insurer claimed she could 'do light work.' We obtained an FCE showing severe fatigue and pain limiting sedentary activity. The insurer reinstated benefits and paid **$185,000** in retroactive compensation.
Frequently Asked Questions
Conclusion
A denial from your employer's insurer isn't the end of your claim — it's the beginning of a process that can still lead to full compensation.
Denials are common but often reversible
You have a right to full transparency about how your claim was assessed
Strong medical and functional evidence changes insurer behaviour
Alberta law protects employees from unfair or bad-faith disability denials