Do You Understand the Definition of Disability in Your Group Insurance Policy?

By Roger Foisy on October 1st, 2015

I recently wrote about the importance of fully understanding your long term disability group insurance policy. If you do not understand your policy, you may find that you don’t receive as much compensation as you are expecting; or, you may fail to ensure that the records of your current salary are kept up to date, in which case you would not receive the full amount you are due. 

Another important element of your group insurance policy that you must pay close attention to is your plan’s definition of disability. Slight changes in language can mean very different things when it comes to your eligibility for claiming long term disability (LTD) insurance and when you are expected to return to work.

DisabilityOwn Occupation vs. Any Occupation

Check the wording in your policy. Does it say you are covered if you are unable to work in your own occupation or in any occupation? Typically in a group insurance policy, your first two years on LTD is covered for your own occupation. After two years, it often becomes any occupation. However, you must inspect your own policy to find out what applies to you.

Own Occupation:

Can you do the tasks required for the occupation you were performing before you became disabled? For example, if you’re a receptionist, can you answer the phone, sit for long periods of time, use a computer, etc.?

Keep in mind that “your own occupation” does not mean “your own occupation at your specific place of employment”. If your insurance company determines that you should be able to do your job, just not at your current place of employment, they will likely not provide you with LTD coverage.

This is an important distinction to remember, because the insurance company may argue that your workplace is toxic and it is causing your disability. Then, instead of compensating you for your disability, they will suggest you could move to a better environment. As far as they are concerned, you should now be able to do the job in this new workplace.

In LTD claims for psychological disabilities, it can be particularly difficult to show the insurance company that your psychological struggles are not a result of your specific workplace, and will not be solved by simply moving you to a different environment.

Any Occupation:

Can you do the tasks required for any occupation? If your insurance company determines that you are well enough to do any type of work – not just that which you did before you became disabled – then you will no longer receive your coverage.

If you believe you are still significantly disabled and cannot return to any type of work, you may need to enlist a long term disability lawyer to make a case on your behalf.

Tasks of Your Employment

You must understand what the tasks of your employment actually are, and exactly what it is that you are unable to do.

For example, “substantially unable to complete the tasks of your employment” is different than “substantially unable to complete the essential tasks of your employment”. Do you know what the essential tasks of your employment are? You should have an accurate job description, so if you go on disability you will be able to properly articulate what those tasks are.

Most employees perform tasks beyond those listed in their official “job description”. Make sure your job description aligns with what you actually do day-to-day.

If you do understand the tasks of your employment, does your employer?

In some cases, employers don’t really know what tasks their employees are performing. If your employer submits a job description to the insurance company that does not capture all of the real tasks you perform, those unreported tasks will not be considered in your disability claim.

Do You Meet the Definition of Disability?

Meeting your insurer’s definition of disability may depend on the wording in your group policy, and whether you and your employer both understand the tasks you perform in the course of your work.

Review your group policy and ask your employer and your insurer any questions you have to ensure you fully understand the definition of disability. You should also discuss your role with your employer and confirm they are aware of the various tasks you perform – even if it requires updating the job description.

>> Roger R. Foisy is an experienced long term disability lawyer in Ontario who helps clients receive the long term disability compensation they deserve. Do not hesitate to contact Roger and his team today for immediate support and a free consultation.

Watch my Long Term Disability Video Series for answers to some common LTD questions.

More on Long Term Disability from Roger R. Foisy:

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