Change of Definition for Long-Term Disability Benefits
What does ‘Change of Definition’ Mean?
If you meet the necessary criteria, you are entitled to long-term disability benefits immediately after your short-term disability benefits end. Most long-term disability policies and group plans require the insurance company to provide disability benefits as long as you are unable to work due to a disabling condition. The problem encountered by many disability claimants is that the definition of a disability changes after a certain period of time - typically two years - from the ‘Own Occupation' definition to the ‘Any Occupation’ definition. This change can affect whether you continue to be entitled to disability benefits. The text of each policy and plan is different so be sure to check the wording of your own group disability plan or individual disability policy text.
The ‘Own Occupation' Definition
Under the ‘Own Occupation’ definition, you are disabled if, as a result of your medical condition, you are unable to complete the tasks and duties required for your own occupation. Your own occupation is the occupation that you had when you began receiving the long term disability benefits. To satisfy the ‘Own Occupation’ definition, you must show that you are totally or substantially disabled from completing the duties of your own job. To satisfy this test, you do not need to prove an inability to perform every task of your occupation. You only need to show that (1) the duties you are unable to perform are central to your work, and (2) your inability to perform these duties is linked to your medical condition.
If you are at this stage, a lawyer can help you compile the necessary evidence to show that you meet the ‘Own Occupation’ definition of a disability due to your medical condition. The lawyers at Freedom Disability Lawyers are experienced in the area of disability benefits, and can work with you to create an effective strategy for your long-term disability claim
The ‘Any Occupation’ Definition
With most long term disability insurance policies, two years after you begin receiving long-term disability benefits, the definition of a disability changes from the ‘Own Occupation’ definition to the ‘Any Occupation’ definition. Under the ‘Any Occupation’ definition, you must establish that you cannot perform any occupation that you are reasonably suited for. This is a more onerous standard than the ‘Own Occupation’ standard.
What does it mean to be ‘reasonably suited’ for a job? Insurance companies determine what jobs you are reasonably suited for by assessing your education, training, and experience. Given the number of different jobs that exist, it may seem inevitable that insurance companies will be able to propose a job that you are able to do. However, insurance companies can only consider whether you are able to perform jobs that are commensurate with your current salary and level of responsibility. This limits the number of jobs that will be considered when determining whether your condition makes you unable to work under the ‘Any Occupation’ definition. You will have to review your group plan or individual policy text to determine income thresholds and geographic limits that may apply to the scope of qualifying jobs under the ‘Any Occupation’ test.
You may learn that your long-term disability benefits are being terminated because the insurance company has determined that your medical condition does not meet the more onerous ‘Any Occupation’ definition. The decision to terminate your claim is generally made on the recommendation of medical consultants who work for the insurance company. These consultants will often provide poor justifications for terminating your long-term disability benefits. Insurance companies who terminate your disability benefits may assume you will simply accept this decision, but you should know there are other options available to you.
How Can Freedom Disability Lawyers Help?
If your long-term disability benefits are being terminated following the ‘Change of Definition,’ consult a lawyer about appealing the decision of the insurance company. There are three possible outcomes to your appeal of the decision of the insurance company:
1. Your health has improved sufficiently to allow you to return to work and the appeal is unnecessary;
2. A determination is made that you should receive benefits and you are reactivated, essentially granting the appeal;
3. The insurance company determines that there is some merit to your appeal and you are able to negotiate an appropriate long-term disability settlement with them.
If you are interested in appealing the termination of your benefits, contact Freedom Disability Lawyers to book a free case consultation. We will review your insurance policy and your medical file to assess the potential courses of action that are available to you. We can gather medical evidence and details about your occupation to support your claim. At Freedom Disability Lawyers we have a doctor on staff that works directly with our legal team. You will be supported every step of the way!
Freedom Disability Lawyers only practices in the areas of injury and disability. We are dedicated to our clients. You can learn more about how we handle disability claims here.
If you are in need of legal advice or representation for your disability benefits claim, we serve clients across Canada. Contact us today and tell us more about your claim - we are here to help!
