Canada Life / Great-West Life Claim Denied? How to Appeal in Canada

Canada Life — formerly Great-West Life, now incorporating the London Life brand following the 2020 consolidation — is one of Canada's largest insurers and financial services providers. Canada Life is particularly significant in the group benefits market, administering employer-sponsored plans for millions of Canadian employees. The company also holds the major contract to administer the Public Service Health Care Plan (PSHCP) for federal public servants, RCMP officers, and retirees. If Canada Life has denied your claim, you have defined rights to challenge that decision through internal and external channels.

Why Insurers Deny Canada Life / Great-West Life Claims

Long-term disability denials — insufficient medical evidence. Disability claims are the most contested category. Canada Life denies or terminates LTD benefits on the basis that medical evidence does not establish total disability from the claimant's own occupation (own-occ definition) or any occupation (any-occ definition). The own-to-any-occupation transition at 24 months is a particularly common denial trigger.

Group health benefits not covered under the plan. Canada Life administers many different benefit plans with varying coverage levels. Denials occur when the specific service is not covered at your employer's plan level, or when coverage limits have been exhausted. The employer (plan sponsor), not Canada Life, determines benefit design — but Canada Life administers the rules.

Drug formulary exclusion. Canada Life may deny prescription drug claims for medications not on your plan's approved formulary, for brand-name drugs when generics are available, or for specialty biologics requiring special authorisation.

Prior authorisation not obtained. Certain services and medications require advance approval. Claims submitted without documented prior authorisation are denied.

PSHCP-specific disputes. The federal Public Service Health Care Plan has specific benefit schedules that differ from standard commercial plans. Denials under the PSHCP often involve misapplication of the plan's specific benefit provisions, and the appeal process runs through Canada Life's PSHCP claims administration.

Pre-existing condition exclusion. Some policies include pre-existing condition limitations that restrict coverage for conditions present before coverage began.

How to Appeal a Canada Life Denial

Step 1: Identify Your Plan Type and Coverage Document

Determine whether you are appealing a group benefits claim (employer-sponsored or PSHCP) or an individual insurance claim. Request your complete plan booklet or policy document. For PSHCP members, review the PSHCP Plan Document available through your employer or on the Treasury Board of Canada website. Understanding the exact benefit terms is essential before filing your appeal.

Step 2: Request Canada Life's Complete Claims File

Under provincial insurance legislation and, for group benefits, the plan terms, you have the right to request the complete documentation supporting Canada Life's denial decision. For disability claims, this includes internal case management notes, independent medical examination (IME) reports, functional capacity evaluation results, and vocational analysis reports. Reviewing this file reveals the specific grounds for denial and helps you target your response.

Step 3: Obtain Comprehensive Medical Evidence from Your Treating Physicians

The most critical element of any Canada Life appeal is strong, detailed medical evidence. Your treating physicians should provide narrative reports addressing the specific denial criteria Canada Life applied. For LTD claims, the report must include specific functional restrictions (hours of sitting, standing, walking; cognitive limitations; medication side effects affecting work capacity), not merely the diagnosis. Counter any IME report with opinions from your own treating specialists.

Step 4: File the Internal Appeal with Canada Life

Submit a written internal appeal within the timeline specified in your denial letter (typically 90–180 days). Address each denial reason with specific evidence. Reference the applicable plan provisions. For PSHCP claims, follow the Canada Life PSHCP appeals procedure outlined in the plan certificate. For disability claims, note that the administrative record established during your appeal is critical if the matter proceeds to litigation.

Step 5: Escalate to the OmbudService for Life and Health Insurance (OLHI)

If Canada Life's internal process does not resolve your dispute — you receive a final position letter or 90 days pass without resolution — escalate to OLHI (OmbudService for Life and Health Insurance) at olhi.ca. OLHI is free for consumers, handles disputes about individual and group life, health, dental, disability, and critical illness insurance, and issues recommendations that Canada Life is expected to follow as a CLHIA member. File online or call 1-888-295-8112.

Step 6: Provincial Regulator and Litigation

Provincial regulators investigate complaints about unfair claims handling. Ontario: FSRA (fsrao.ca). British Columbia: BCFSA (bcfsa.ca). Alberta: Treasury Board Finance. Quebec: AMF (lautorite.qc.ca). For LTD denials where the internal and OLHI processes fail, consult a disability insurance lawyer — many work on contingency. Provincial limitation periods (typically two years from denial) must not expire while pursuing administrative remedies.

What to Include in Your Appeal

• Canada Life's denial letter and any IME or functional capacity evaluation reports relied upon
• Treating physicians' narrative reports with specific functional restrictions addressing the denial criteria
• Complete clinical records, diagnostic test results, and treatment history
• Plan booklet or policy document confirming the applicable benefit terms
• OLHI referral documentation if the internal process has been exhausted

Fight Back With ClaimBack

Canada Life administers enormous claim volumes and denies disability benefits in patterns that are predictable and contestable with the right evidence. OLHI provides a free escalation pathway that frequently reverses internal denials. A complete, well-structured appeal with strong specialist evidence gives you the best foundation for reversal. ClaimBack generates a professional appeal letter in 3 minutes.

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Related Reading

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal