An Insurer’s “Change of Definition” Test

When you apply for long term disability benefits, it is because you are unable for health reasons to continue working in your role. Your health has become compromised to the point where you can no longer continue to function within your day-to-day essential duties, and need time off of work in order to regain your health. Disability benefits are meant to support you financially during the time that you are off work, so that you do not have the added strain of worrying about your finances during that difficult time.

 

What happens, though, when your health does not improve sufficiently enough to return to work?

 

Video: Will my insurance company force me to go to work?

The Change of Definition Test – An Example

 

Ruth has been unable to work for nearly two years as a result of an injury. She was able to successfully access her long term disability benefits, which has helped to replace a portion of her income while she deals with countless doctor visits, physiotherapy sessions, talk therapy appointments, and everything else that she could do to prioritize her healing. 

 

While Ruth’s benefits were helpful in the beginning, she recently received a letter from her insurance company stating that her benefits will be cut off in a few weeks, at the 2nd anniversary of the date she stopped working, because the insurance provider believes that while Ruth may not be able to do go back to her own role, she is not entirely incapable of working. 

 

Ruth’s disability policy includes a change of definition for what constitutes total disability, which is common around the 24-month mark for long term disability benefit recipients. At the change of definition, even though she may not be able to work within her own occupation that she was doing when she was first unable to work, she is physically well enough to work in any occupation that suits her education, experience, or skills. 

 

Video: What is a “Change of Definition Disability”

Ruth did not understand, and wrote to her insurance company to inform them that she was still unable to work, she was still medically incapacitated and still undergoing treatment. Her insurance company held firm, telling her that they believed based on her current medical condition she could do some form of other work to earn income. Because they believed that there were alternative jobs that she could do, they took the position that they no longer needed to support her financially.

 

Ruth was understandably devastated by the news. The insurance company cannot see the constant pain that she is in, and the ravages that that has taken on her body. Her injuries include nerve compression which leaves her in severe constant pain, and makes it impossible for her to sit or stand for any long periods. She is also easily distracted because the pain is so severe that she has a difficult time focusing, remembering things, or even maintaining a conversation. 

 

How Share Lawyers Helped

 

Thankfully, a friend recommended that Ruth contact Share Lawyers. Her friend told her that Share are experienced disability lawyers who understand the complexities of long recovery periods, and regularly take formal legal action to have denials overturned. Ruth met with a lawyer who explained to her that even though the insurance company said no, there were legal options available to force their hand into continuing to pay out her benefits. 

 

Ruth worked with her to collect all of the medical documentation that she needed to support her case. She was grateful to be partnered with Share Lawyers going through the litigation process, where ultimately her lawyer was successful in negotiating a favourable settlement of her claim. Now Ruth can continue with her therapies and focus on finding new coping strategies for living with her pain without having to panic about her finances as well.

 

At Share Lawyers we have over three decades of experience fighting disability denials for clients exactly like Ruth. We understand the change of definition test backwards and forwards, and the reality is that some people are simply not well enough to return to work just because 24 months has magically passed. Contact us today to set up a free consultation.  


Video: Own Occupation, Any Occupation and the Change of Definition Point

If you have had your claim for long-term disability denied, contact the long-term disability insurance lawyers at Share Lawyers. Our experienced team of long-term disability (LTD) lawyers can help. We have recently settled cases against Canada Life, Desjardins, Manulife, RBC Insurance, Sun Life, and many more. We offer free consultations and there are no fees unless we win your case. Find out if you have a disability case.

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