When Does Long-Term Disability Change From “Own Occupation” to “Any Occupation” in Ontario?

By Lane Foster

Personal Injury and Long-Term Disability Lawyer

Most long-term disability (LTD) policies in Ontario change from an “own occupation” definition of disability to an “any occupation” definition after about 24 months of benefits. At that stage, claimants must usually show they cannot perform any job they are reasonably suited for based on their education, training, or work experience, not just their previous occupation.

This definition change is one of the most common points where insurance companies reassess long-term disability claims. As the two-year mark approaches, insurers often review updated medical evidence, vocational reports, and functional testing to determine whether benefits should continue.

What does “own occupation” mean in long-term disability insurance?

“Own occupation” means a person is considered disabled if their medical condition prevents them from performing the substantial duties of the job they held before becoming disabled.

During this stage of a claim, the focus is on the claimant’s actual occupation, not whether they could theoretically perform other types of work.

For example, someone working in construction who suffers a serious back injury may qualify for long-term disability benefits if their condition prevents them from performing physical labour, even if sedentary work might theoretically be possible.

Similarly, professionals such as nurses, tradespeople, and emergency responders may qualify if their condition prevents them from performing the duties required in their specific occupation.

What does “any occupation” mean in long-term disability policies?

Under an “any occupation” definition, a claimant must show they are unable to perform any job they are reasonably suited for based on their education, training, or work experience.

This definition is stricter than the own occupation standard.

Insurance companies may argue that even if a claimant cannot return to their previous job, they could still perform another form of employment such as administrative or sedentary work.

Disputes often arise over whether the alternative jobs suggested by the insurer are realistic given the claimant’s medical condition and employment background.

Why do insurance companies reassess LTD claims after two years?

Many long-term disability policies require insurers to reassess eligibility when the definition changes from own occupation to any occupation.

Insurance companies often review claims at this stage and use evidence such as:

• updated medical reports

• independent medical examinations

• functional capacity evaluations

• vocational assessments

• surveillance investigations

Claimants insured through companies such as: Canada Life, Manulife, and Sun Life Financial may experience detailed file reviews as the 24-month definition change approaches.

These reviews often determine whether benefits will continue or be terminated.

Can long-term disability benefits stop after two years?

Yes. Many LTD benefits are reassessed after about two years because the policy definition of disability changes.

If the insurance company concludes the claimant could perform another occupation under the policy’s definition, it may terminate benefits.

However, disputes frequently arise over whether the insurer properly evaluated the claimant’s medical limitations and realistic employment prospects.

How do courts assess “any occupation” disability cases?

Courts in Ontario will typically assess whether the alternative employment proposed by an insurer is actually realistic in light of the claimant’s medical condition and work history.

Factors courts frequently consider include:

• the severity and permanence of the claimant’s condition

• education and employment history

• chronic pain or cognitive limitations

• the availability of suitable employment

• the credibility of vocational evidence

Courts have sometimes rejected insurer arguments where proposed jobs were largely theoretical rather than realistic employment opportunities.

Can you challenge an LTD termination after the definition change?

Yes. If an insurer stops long-term disability benefits after the definition changes to “any occupation,” the decision can be challenged.

Often claimants can argue the insurer incorrectly concluded they could perform other employment despite ongoing medical limitations.

Individuals facing termination of benefits may wish to seek advice from an Ontario long-term disability lawyer about their legal options.

Key Takeaway

The transition from own occupation to any occupation is one of the most important stages of a long-term disability claim.

Many disputes arise at this juncture in the process because insurance companies may conclude a claimant can perform other work even when significant medical limitations remain. They may often realize they would have to make significant financial payments in the future if they do not terminate the claim at this stage.

Understanding how insurers evaluate disability at this stage can help claimants prepare for the review process and respond if benefits are terminated. Learn more here about denied Desjardins disability claims.

Lane Foster is a personal injury and long-term disability lawyer in Ontario who represents clients in disputes involving denied or terminated disability insurance benefits.