Many people are shocked when their long term disability benefits suddenly stop after two years. This is one of the most common reasons insurers deny or terminate benefits, and it often comes down to a change in how disability is defined in your policy.
If your benefits are approaching the two year mark, or have already been cut off, it is critical to understand what is happening and what your legal options are.
The “Own Occupation” vs “Any Occupation” Change
Most long term disability policies in Ontario have two stages.
For the first two years, you are considered disabled if you cannot perform the essential duties of your own job.
After two years, the definition changes. You must now prove that you are unable to work in any occupation for which you are reasonably suited by education, training, or experience.
This shift is often referred to as the “any occupation” test, and it is where many claims are denied.
Why Insurers Cut Off Benefits After Two Years
Insurance companies routinely reassess claims at the two year mark and look for reasons to terminate benefits.
Common reasons include:
1. The insurer claims you are capable of lighter or alternative work
2. They rely on paper reviews by their own doctors
3. They conduct surveillance or review your social media
4. They argue your condition has improved
5. They say your limitations do not prevent all work
In many cases, these decisions are made despite ongoing symptoms and medical support from your treating doctors.
What Counts as “Any Occupation”?
This is not as broad as insurers suggest.
You are not required to take just any job. The role must be reasonably suited to you based on:
– Your education
– Your work history
– Your skills and experience
– Your physical and cognitive limitations
– Your level of income compared to your pre-disability job
For example, a professional cannot simply be told to take a minimum wage job if it is not reasonably comparable.
Common Mistakes Claimants Make
Many people unintentionally weaken their claim at this stage.
Common issues include:
– Not updating medical records to address work capacity
– Attempting a return to work without proper documentation
– Underreporting symptoms to doctors
– Posting activities online that are taken out of context
– Accepting the insurer’s decision without challenge
What You Should Do Before the Two Year Mark
If you are approaching two years on LTD, preparation is critical.
You should:
1. Speak to your doctors about the “any occupation” test
2. Ensure your medical records clearly outline your restrictions
3. Document how your condition affects your ability to work
4. Be cautious with social media and public activity
5. Consider getting legal advice early
What If Your Benefits Are Cut Off?
If your long term disability benefits are terminated, you have legal options.
You may be entitled to:
– Reinstatement of benefits
– Payment of past benefits
– Damages for breach of contract
– In some cases, aggravated or punitive damages
Most LTD claims in Ontario proceed by way of a lawsuit against the insurer.
It is important to act promptly, as limitation periods apply.
The Reality of LTD Denials After Two Years
The two year cutoff is one of the most litigated issues in disability law. Insurers often take aggressive positions at this stage, but many denials do not hold up when properly challenged.
Courts in Ontario frequently side with claimants where the evidence shows they are not realistically employable.
Speak With a Long Term Disability Lawyer
If your benefits are being reviewed or have been cut off after two years, you should seek legal advice before accepting the insurer’s decision.
At Landy Marr Kats LLP, we act for individuals whose disability benefits have been denied or terminated. We understand how insurers approach the “any occupation” test and how to challenge improper denials.
We offer free consultations and do not charge fees unless we recover compensation for you.