I often receive calls from people who have been denied long term disability benefits (LTD benefits) or income replacement benefits (accident benefits) on the basis that their insurer says that they do not meet the “any occupation” test.
The “Any Occupation” test for disability benefits typically becomes the governing test after two years of disability. When you first read it, it is a scary thing – “Any occupation” – so does that mean if a CEO can’t do their job, but can now work for 10 minutes every second day as a tele-marketer the insurer can cut them off? Thankfully, the answer to that question is no.
The meaning of the “any occupation” test has been studied and interpreted by our Courts in Ontario and elsewhere and it is clear that the Courts favour reasonableness when interpreting the provision. It is also important to remember that the injuries must be looked at as a whole – it is not appropriate for an insurer, for instance, to say that you are physically able to return to work and ignore the effects of emotional and cognitive problems.
The Courts will look at whether the overall employment is reasonable considering all of its duties, they will consider the reasonableness of the type of job, the type of compensation and other factors when considering whether the person meets the any occupation test. It is imperative that you speak with a lawyer if you have been denied benefits.
It is very important that you receive independent advice about whether the insurer’s denial is appropriate and whether there are any steps that you need to take. There are time-limits that can also take away your right to sue.
Call us today for a free consultation. Steven Polak is a lawyer who restricts his practice to injury and disability claims. He is a partner with Lerners LLP (since 1929 and over 100 lawyers strong) and a member of the Ontario Trial Lawyers Association Long Term Disability Litigation section.