How Long is Long Term Disability?

Long term disability (LTD) is a type of insurance intended to provide a source of income in the event you become disabled from employment due to illness or injury.  Given that some disabilities last longer than others, the question “How long is long term disability?” is quite common.  The answer depends on multiple factors, including: the terms and conditions of the policy, the duration of the disability, and the definition of disability. 

The Policy

All policies of insurance are contracts. The policy will specify the essential terms of the contract, including who is insured, the amount of the benefit, and other conditions including how long disability benefits are potentially payable. 

Most LTD policies specify that benefits stop at age 65, which coincides with the historical retirement age.  Occasionally benefits will end at an earlier or later age, and in other cases benefits are only payable for a specified number of years after the onset of disability, regardless of age. 

The starting point, therefore, should be to read the policy.  If you are a member of a group benefit plan, the benefit booklet should contain this information. 

So Long As You Remain Disabled

Long term disability policies do not automatically pay to the maximum end date.  

If you are able to return to work, benefits will stop. Most insurance companies will support a gradual attempted return to work, including payment of full or partial benefits while transitioning back to gainful employment.  If an attempted return to work is not successful, benefits may or may not resume, depending on whether the insurance company accepts you put forth a full effort.  If the insurer accepts you cannot return, it is important to consider the recurrence provisions of the policy.  Depending on the length of time back at work, a new claim and new waiting period may result. 

If a return to work is not likely, the LTD insurer is still only required to pay benefits so long as you can demonstrate that you remain disabled from employment.  It is therefore necessary to provide periodic updates to the insurance company, including medical records and reports. It may also be necessary to answer other information requests, or even attend an assessment with a physician of the insurer’s choosing. 

Unfortunately, many claims are denied even when treating doctors support disability.  If your claim is denied for any reason, you should consult a long term disability lawyer immediately. 

Change of Definition: “Own Occupation” or “Any occupation”

“Disabed”, “Totally Disabled”, “Total Disability”, “Gainfully Employed” and other onerous sounding terms are defined in the LTD policy.  To complicate matters further, the definition of disabled typically changes after two years. 

In most policies, for the first two years, you must demonstrate that you are disabled from performing the essential or important duties of your “own occupation”.  After two years, the test of disability typically changes from being disabled from your own occupation, to being disabled from “any occupation”.  The any occupation test sounds difficult to meet, but any occupation does not mean any job in the literal sense.  Rather, you are still entitled to benefits unless you are capable of working in an occupation that can accommodate your limitations, and for which you have the necessary training, education, and experience.  In addition, the pay must be commensurate.  For example, someone who has worked in construction for more than 20 years cannot be expected to perform office administration.  Similarly, a highly trained professional is still entitled to benefits even if it is possible to work in a less cognitively demanding, but significantly lower paying position. 

Unfortunately, insurance companies regularly misapply the any occupation test of disability, resulting in claims being unfairly denied. 

Conclusion

LTD policies are insurance contracts that have limits on how long benefits are payable. Although many policies theoretically pay to age 65, practically very few individuals receive benefits to the policy end date.  Claims typically end when there is a return to work, inadequate information to support ongoing disability, or when the definition of disability changes from own occupation to any occupation.  

If your claim has been denied, contact Michael Jordan for fast, free, legal advice.  Michael is a Toronto LTD lawyer with offices in London and Ottawa, serving all of Ontario.

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Michael Jordan
Matthews Abogado LLP

Direct Cell: 416-460-6823
Email: mjordan@matthewsabogado.com

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Don’t let the insurance company get away with an unfair denial of your claim. Call now to speak directly with Michael, or complete our confidential form for a quick response, usually within 15 minutes. Michael will guide you through the claims and appeals process, and answer any LTD questions you may have, free of charge.

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