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Review the definition of "Disability" in your Long Term Disability policy.

May 03, 2016, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

The Definition of Disability

A very important part of any long-term disability claim is the definition of disability under the particular insurance policy at issue.    The definition of disability is a critical   part of the test that is applied when an insurance company or court is trying to decide whether or not you are entitled to receive long-term disability benefits.

It is important to know that all long-term disability policies are not created equal.  Similarly, all definitions of disability are not the same.  In fact, the definition of disability (and your level of protection) can vary greatly from one insurance policy to another. 

For example, an insurance policy may indicate that   you are entitled to receive long-term disability benefits if you are able to provide sufficient medical proof that you are totally disabled and unable to perform all of the required duties of your own occupation (i.e. your regular job duties  as they existed  prior to your last day of work).   This is commonly referred to as the “own occupation” period or test.

Some policies however, may set out specific job duties or a specific percentage of job duties that you must be able or unable to perform in order to receive long-term disability benefits.  Other policies may require you to remain totally disabled from performing the duties of any job or position that may be available with your particular employer or company. 

Another fairly common definition of disability is one requiring that you remain totally disabled from performing the duties of any occupation.  This will usually include any different or alternative occupations (i.e. as compared to the duties of your own occupation.)  This is typically referred to as the “any occupation period or test.   Quite often, the any occupation policy wording and test will take into consideration your education, training and work experience as well as any potential income amounts.

A long-term disability policy may in fact include more than one definition of disability.  In this situation, the policy will typically require an initial period of total disability relating to your own occupation (ex. 12 months or 24 months).  This is usually followed by a period where the test for continued long-term disability benefits changes to that of any occupation.  The any occupation test is often a more difficult test to meet.  The point in time, when the definition of disability changes under the policy, is commonly referred to as “the change of definition” date or “definition change”.

Long-term disability policies will usually contain a “qualifying period” (i.e. a specified minimum period of time that you must remain disabled before being able  to start receiving long-term disability benefits).  Most long-term disability policies will also require that all short-term disability benefits are paid in full before you can start to receive long-term disability benefits.  Some long-term disability definitions may specifically require that your disability be “continuous” (i.e.  daily, constant,  uninterrupted). 

Certain disability definitions may also require you to provide “objective” medical evidence in order to support a claim for long-term disability benefits.  “Objective” medical evidence is typically   considered to be evidence or opinions   provided by third party sources (ex. treatment providers, medical experts, medical test results etc.).  This is different than “subjective” evidence (i.e. your own indication or description  of  any symptoms or work limitations).

In the circumstances, it is critical that you review your disability policy wording in order to determine and understand exactly what definitions and tests apply to you.  It is also very important for you to review your disability policy wording in order to make sure that the wording of your  disability policy is right for you.

Posted under Car Accidents, Chronic Pain, Disability Insurance, Fractures, Pain and Suffering, Personal Injury, Treatment

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About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us toll-free at 1-866-414-4878.

The opinions expressed here, while intended to provide useful information, should not be interpreted as legal recommendations or advice.

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