Change of Definition & LTD Insurance

In a long term disability claim, the change of definition refers to a change in the definition of what it means to be disabled according to your disability policy. Commonly you will see that this takes place after 24 months of being on long term disability.

The change of definition usually refers to a transition from an “own occupation” definition, to an ”any occupation” definition. During the initial disability period, benefits are payable if you are unable to work at your “own occupation.” After the change, benefits are payable only if you cannot work at “any occupation” for which you have the required education, skill, or experience. There are variations in the wording, but this summarizes the typical Change of Definition. Typically, this means that in order to qualify for LTD benefits in any occupation period, you must be totally or substantially disabled from the duties of any occupation for which you have the requisite education, skills, or experience.

Where previously the insurance companies have looked at your ability to go back to doing your job in Hamilton, they are now looking to see if you can do any other job. Your insurance company may try and define this very loosely stating that if you can earn minimum wage working a job for example as a parking attendant then you have the ability to work and are not entitled to your disability benefits further.

Any Occupation has to be a Similar Job at a Similar Payscale

The insurance company doesn’t care where you work, they simply want you off claim. However, if they are saying you can work, it has to be at a job that’s at a similar skill level to what you were doing and at a similar pay scale. If you can’t do that, they should continue to pay your long term disability benefits. You have worked very hard and should not have to sacrifice because your insurance company doesn’t want to pay you further. Your insurance company is saying you can find another job, but that is not the same as the reality of finding and keeping another job.

Finding a New Job When you Need Medical Accomodations Can be Challenging

When confronted with the idea of finding another job, you have to consider how your medical conditions affect your ability to work, the experience you need for the job, and accommodations you would need to be able to work. It will be very difficult to be hired if you are asking for accommodations prior to employment. If you and your doctor agree that you should not return to work, you have several options for next steps.

While you can appeal the insurance company decision, unless there is some dramatic medical evidence or change in your condition that makes it clear that you are not able to work in any capacity, they will continue to deny your long term disability claim. We recommend hiring a long term disability insurance lawyer to fight the insurance company instead of appealing your LTD denial.

Many insurance companies believe that very few people qualify for benefits in the “any occupation” period, basing their adjudication on a paper review by their doctors, none of whom have your best interests in mind. Your insurance company’s concern is the money they can save by stopping payment to you. If this happens, it is important that you find legal representation right away.

You can learn even more about the Change of Definition on our website, including what to do if your benefits have been cut off.

Questions? Contact Hamilton's long term disability insurance lawyers at Share Lawyers. Our 35+ years of experience in long term disability (LTD) law can help you win your case against Canada Life, Desjardins, Manulife, RBC Insurance, Sun Life, and other insurance companies. We offer free consultations and there are no fees unless you win your case. Join us on Facebook and become a Top Fan for a chance to win each month.

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