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Long Term Disability – What is the Change of Definition?

Long Term Disability – What is the Change of Definition?

What is the Change in Definition in Long Term Disability Cases?

Typically, LTD policies contain a provision that considers a person eligible to receive benefits if he is disabled from working at his own occupation for the first two years. This is known as the “own occupation” (own occ) period. Thereafter, the test changes to a more difficult definition which requires the individual to be disabled from performing any occupation for which he is reasonably suited (language like “qualified, or could become qualified for, by reason of education, training or experience”). This is known the “any occupation” (any occ) period.  The juncture between the two definitions of total disability is known as the “Change of Definition” or the “COD”.

Because the test for the “own occ” period is less onerous, and the insurance company’s potential exposure is lower, insurers will often pay benefits during the “own occ” period, but resist paying benefits into the “any occ” period. During the latter period the potential payout, especially for a young person, could be significant.

Before the “own occ” period expires, the insurance company may:

  • Send the insured to one or more independent medical examinations (IMEs) with a view to obtaining medical evidence to use to support terminating the claim at the end of the “own occ” period. For a precedent letter you can adapt to send to your client advising of an upcoming IME, see Standard Document, Letter to Client re: Upcoming Defence – Medical. See also Standard Document, Post-defence Medical Questionnaire; and Practice Notes, Working with Litigation Experts and Expert Reports: Overview.
  • Conduct Surveillance
  • Obtain Medical Opinions – insurers will more likely than not obtain medical opinions regarding the insured’s level of disability and whether he meets the “any occ” definition or whether a termination of benefits can be supported.

Have you been Denied your Long-Term Disability Benefits?

If you have been denied your long-term disablity benefits, call us today at 905-333-8888 or toll-free across Ontario at 1-844-LALANDE for your free consultation. Matt Lalande has been litigating wrongfully denied disability benefits since 2003 – and is happy to speak to you about your disability issue at no cost to you. If you decide to work with us, we never ask for money upfront and work on contingency with a no fee guarantee.

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