Ryan Findlay | February 6, 2025 | Long-Term Disability
How Courts Interpret ‘Any Occupation’ in Long-Term Disability Cases
Many disabilities can prevent a person from working. If you cannot work because of a disability, you may be entitled to long-term disability benefits under a disability insurance policy. Generally, the timeframe for long-term disability focuses on two periods: the first 24 months and 24 months until 65 years old.
During the first 24 months, qualifying for disability benefits focuses on whether you can perform the duties required for your “own occupation” as defined in the policy. After the first 24 months, the focus shifts to whether you can perform duties for “any occupation.” How the court defines “any occupation” can determine whether you continue receiving long-term disability benefits.
Change of Definition for Long-Term Disability Benefits
When you file for long-term disability (LTD) benefits, the insurance company determines if you can perform the duties required for your job. During the period defined by the Own Occupation Test, the insurance adjuster determines if you can perform your job without restrictions. If your condition prevents you from performing your job duties, you can continue receiving long-term disability benefits.
However, long-term disability insurance policies contain a clause for a Change of Definition. At the end of two years, a disability determination is made based on an Any Occupation Test instead of the Own Occupation Test.
The insurance company investigates your claim to determine if your condition has improved or changed. It also performs a Transferable Skills Analysis. The analysis determines if your skills can be used to perform any occupation. If so, the company must also consider whether your restrictions prevent you from performing specific jobs.
If your skills and limitations allow you to perform any type of work, the insurance company may terminate disability benefits. Unfortunately, “any occupation” is broadly defined and subjective.
How Is “Any Occupation” Defined for Long-Term Disability Benefits in Ontario, Canada?
Generally speaking, “any occupation” for total disability is defined as whether a person’s condition allows them to engage in any reasonable, gainful employment for which they are or can become qualified through their training, skills, education, or experience. The courts have broadly addressed the definition of disability for the Any Occupation Test.
In MacEachern v. Co-operative Fire & Casualty Co. (1987), 196 A.P.R. 127 (N.S.C.A.), the court found that the claimant had to have a total and permanent disability to qualify for disability benefits. “Total and permanent disability” is defined as a disability that causes a worker to continually and wholly be prevented from engaging in an occupation for profit or wages. The person is qualified or could become qualified by reason of their training, education, and experience.
Courts have found that determining whether a person is totally disabled for the Any Occupation Test is subjective. All matters must be considered, but the circumstances are unique to the person.
In other words, the insurance company bases the decision on objective medical findings AND the worker’s personal circumstances and history. Therefore, two people with the same medical diagnosis may have different interpretations of “any occupation” based on their unique circumstances.
A worker might be able to perform some work functions. However, the courts have found that being able to perform some work functions does not necessarily bar someone from receiving benefits under the Any Occupation Test.
Another issue with some disability policies is defining “true work.” In Ferguson v. National Life Assurance Co. of Canada, the court found that total disability for “any occupation” does not mean absolute helplessness. It ruled that the employee could not perform essential tasks to the standard of a reasonable employer.
What Should I Do if I’m Denied Long-Term Disability Based on Failing the “Any Occupation” Test?
A disability insurance company tries to define the disability for the change in definition as narrowly as possible. The goal is to prevent the worker from continuing to receive disability payments. If the insurance company can show that the worker can do “any work,” it will try to deny long-term disability benefits after two years.
If you receive notification of a change in definition and denial of benefits, contact an experienced Hamilton long-term disability lawyer immediately. You may have grounds for appealing the denial, but you must act quickly to protect your rights. A disability lawyer knows how the courts have ruled in these cases and can help you prepare an effective appeal of a denial of benefits.
Contact Our Long-term Disability Law Firm in Ontario, Canada
If you need legal help with a long-term disability case, contact the team at Findlay Personal Injury Lawyers to schedule a free initial consultation today.
Findlay Personal Injury Lawyers – Hamilton, ON
20 Hughson St S #510, Hamilton, ON L8N 2A1
(905) 522-9799
Findlay Personal Injury Lawyers – Brantford, ON
325 West St #102a, Brantford, ON N3R 3V6
(226) 401-5433
Findlay Personal Injury Lawyers – Burlington, ON
2349 Fairview St, Burlington, ON L7R 2E3
(289) 512-0829
Findlay Personal Injury Lawyers – St Catharines, ON
55 King St Suite 207, St. Catharines, ON L2R 3H5
(289) 301-9496
