Long-term disability (LTD) benefits are essential for individuals who become unable to work due to illness or injury. These benefits provide financial support when a person cannot earn an income due to factors beyond their own control. However, many people are unaware that LTD coverage undergoes a significant change after the two-year mark, which can result in some individuals no longer qualifying for benefits. Understanding what happens after two years can help claimants prepare and avoid unexpected disruptions in their benefits.

The Definition of Disability Changes

The most significant shift that occurs after two years on LTD is the change in the definition of disability. During the first 24 months, most policies define disability as the inability to perform the duties of your “own occupation”. This means that if you cannot do your current specific job, you qualify for benefits. After two years, the definition usually changes to the inability to perform “any occupation” for which you are reasonably suited by education, training, or experience. This is a higher threshold to meet, and LTD claims are often denied at this stage. If the insurance company determines that you can work in a different role, even if it pays less or is outside your previous industry, your benefits may be discontinued.

Reassessment of Your Condition

Around the two-year mark, insurers typically conduct a thorough reassessment of your health and functional abilities. This could involve:

  • Conducting surveillance or interviews;
  • Requesting updated medical records;
  • Arranging for independent medical examinations; and/or
  • Reviewing vocational assessments;

The goal of the insurance companies is to evaluate whether you now meet the stricter “any occupation” definition. If the insurer concludes you can work in another capacity, your LTD benefits may end.

Appealing a Denial of Benefits

If your benefits are terminated at the two-year point due to the change in definition of disability, you still have the right to appeal. This involves gathering medical evidence, obtaining expert opinions, and possibly legal representation to support your continued claim. Appealing can be complex and time-consuming, so starting early and being well-prepared is critical to obtaining a desired outcome.

Exploring Other Income Supports

If your LTD benefits end and you’re still unable to work, other income support options may be available:

  • Canada Pension Plan Disability (CPP-D): If you’ve contributed to the Canada Pension Plan and can no longer work regularly in any job because of a disability, you could be eligible for CPP disability benefits. These payments provide monthly income support to help offset your lost earnings. Many LTD plans require that you apply for these if you are eligible, so it is worth reading the terms of your policy closely. 
  • Provincial based disability support programs: Programs such as ODSP in Ontario or AISH in Alberta offer assistance to individuals with long-term disabilities.
  • Employment Insurance (EI) Sickness Benefits: Although short-term, these can provide temporary support.

Maintaining Medical and Legal Documentation

Keeping comprehensive records of your medical condition, treatment, and how your disability affects your daily life is essential. Documentation strengthens your case whether you’re continuing with LTD, appealing a denial, or applying for other support. It may also be wise to consult with a disability lawyer to navigate you through the process. Legal professionals can help navigate policy complexities and advocate on your behalf if your claim is challenged, to ensure that you receive the best possible outcome.

Working While on LTD

Some policies allow you to partake in part-time or modified work while receiving benefits, especially if it aids your rehabilitation. However, this must usually be approved by the insurer and might affect the amount you receive. Transparency and communication with your insurer are essential to avoid jeopardizing your claim.

Get Support for Your LTD Claim

The two-year mark in long-term disability claims is a critical turning point. The shift from “own occupation” to “any occupation” can mean a reassessment and potential loss of benefits. By understanding what to expect, maintaining detailed records, and exploring alternative support systems, claimants can better protect their financial stability. Early preparation and, when necessary, legal support, can make a significant difference in ensuring ongoing support for those who are genuinely unable to return to work.

At NOVA Injury Law, we’re committed to guiding Long Term Disability applicants through every stage of their claim to help them secure the benefits they’re entitled to. Our team handles a wide range of personal injury cases and provides comprehensive support, including complimentary case evaluations with no obligation, a no-win, no-fee payment structure where we only get paid if your claim is successful, and dedicated legal advocacy to pursue the compensation you deserve. 

To learn more or to schedule a free consultation regarding a Long Term Disability claim, contact NOVA Injury Law today.