‘Any Occupation’ Test for Long Term Disability Benefits

In this section, we will go over the ‘any occupation’ test for long term disability benefits, what it means, and why it is required before benefits are paid out. We will explain when this test is required and what the courts look at before considering whether a person meets the ‘any occupation’ test. Let’s take a look at the ‘any occupation’ test for long term disability benefits in Ontario. This article will also provide the difference between ‘own occupation’ and ‘any occupation’ as described in disability matters.

What Is ‘Any Occupation’?

‘Any occupation’ definition of disability states that benefits will only be awarded if an injury or sickness has interfered with the insured’s ability to work in any occupation that they are reasonably qualified for depending on their level of education or previous experience. This test usually becomes a governing test after two years of disability that determine whether the insured still qualifies for benefits.

There are two factors that the courts consider when interpreting this provision for ‘any occupation’. First, the insured’s injuries must be looked at as a whole. This simply means that, if the person is not suffering any physical injuries, it shouldn’t be assumed that he/she is able to return to work by ignoring the emotional and cognitive problems they may be experiencing.

Secondly, the court will look at whether the occupation is something that the insured is reasonably qualified for. For instance, a former CEO cannot be denied benefits because he/she can work as a tele-marketer. The court will consider whether the employment is reasonable by determining the duties, type of job as well as compensation offered compared to the person’s previous work before the disability.

Difference Between ‘Any Occupation’ and ‘Own Occupation’

If the provision in your policy is an own occupation test, on the other hand, you may qualify for benefits if the injury or sickness directly interferes with your ability to perform a substantial part of your own occupation. This provision is usually the most lenient because it considers the insured’s ability to perform their specific job. Unlike ‘any occupation’ which is more difficult to meet, interpreting the ‘own occupation’ clause is usually clearer.

Why You Need Legal Help

If you have been denied benefits because of failure to pass these tests, it’s important to get independent advice to ensure your rights are fully protected. Insurers are known to terminate benefits unfairly by interpreting ‘any occupation’ too narrowly. The judge will consider other factors when interpreting the ‘any occupation’ provision. For instance, the court will look at the availability of work for the insured, how much compensation they’re likely to be paid as well as their mental wellbeing.

An experienced long-term disability lawyer will work hand in hand with the right medical experts to gather evidence that supports their client’s inability to work. For instance, if you are diagnosed with depression, a qualified psychiatrist may be a more suitable expert witness than a doctor to support your case.

Understanding Short-Term and Long-Term Disability Policies with a Hybrid Definition

Your insurance policy may have a ‘hybrid’ definition of disability. This means that it combines some aspects of ‘’own occupation’’ and ‘’any occupation.’’ In general, such policies allow the insured to prove that they cannot perform their occupation for a specific time, after which they must prove that they cannot perform any other occupation. For instance, if the insured finds a job in a new occupation, their earnings can be reduced from the benefit amount. For example, an accountant who was receiving a benefit amount of $8000 a month may have started a new role as a salesperson receiving compensation of $6000 every month. Their new benefit amount could decrease to $2000 if they have a hybrid policy.

The insured needs to understand when the definition of disability is likely to shift again if the policy has a hybrid definition of disability. The typical period is often 24 months. Before this time lapses, the insurer will often re-review the insured’s file to determine if they still qualify for the benefits under the new applicable definition of disability. In many cases, the long-term disability benefits may be terminated when the definition of disability shifts.

An example of a shift in the definition of disability

An employee may be considered disabled if their injuries or illness prevents him/her from:

• Being able to perform the material duties of his/her regular occupation and
• Being able to earn at least 80% or more from his/her regular occupation

After 12 months (or when the hybrid definition applies), the employee is now only considered disabled if the injury or sickness prevents him/her from:

• Being able to perform the material duties of any occupation which he/she could be qualified for based on education, training, or experience
• Being able to earn 80% or more of his/her indexed earnings

This simply shows that, with a hybrid policy, the insured must again prove that they are unable to perform any occupation for which they are or could reasonably be qualified for depending on their level of education or training & experience.

To avoid benefit termination once this shift occurs, you can:

• Request your doctor to provide a statement that explains you’re still unable to perform any occupation.
• Undergo the necessary medical evaluations to show that you are unable to perform any occupation. These may include the Functional Capacity Evaluation and a Neuropsychological Evaluation, which measure physical, cognitive, and mental capacities.
• Obtain a vocational assessment.
• Approach a lawyer to guide you on how to protect your ongoing benefits.