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Own Occupation vs. Any Occupation: Understanding Your LTD Denial
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If your long-term disability benefits were recently cut off after two years, you are not alone. This is a common denial timeline for individuals receiving long term disability benefits . This denial is often caused by a “change of definition” provision in your policy.
The Two Definitions of Disability
Most employer-sponsored LTD policies use two different standards to assess whether you qualify as disabled, and they apply at different stages of your claim.
“Own occupation” means you are unable to perform the essential duties of the specific job you held before your disability. This is the standard that typically applies during the first 24 months of your claim. It is a relatively straightforward test: can you do your job or not?
“Any occupation” is a broader standard. It asks whether you are unable to perform the duties of any occupation for which you are reasonably suited by education, training, or experience. This is the standard most policies switch to after 24 months.
| Own Occupation | Any Occupation | |
|---|---|---|
| Standard | Can you do your specific job? | Can you do any job you are suited for? |
| Typical Period | First 24 months of benefits | After the first 24 months |
| Threshold | Narrower — focused on your role | Broader — any suitable work |
To illustrate: a surgeon who develops a hand tremor would clearly qualify under the own occupation definition because they cannot perform surgery. Under the any occupation standard, the insurer might argue that surgeon could work in a teaching or consulting role and deny benefits on that basis.
What Happens at the 24-Month Mark
At the two-year point, your insurer will reassess your claim under the any occupation standard. This is a scheduled review built into the policy. Even though nothing about your health may have changed, the threshold for qualifying has shifted, and that shift is often enough for the insurer to terminate benefits.
How Insurers Approach the Any Occupation Review
When reassessing your claim, insurers will often:
- Request updated medical information, then argue the evidence does not support a finding of total disability from any occupation
- Commission a paper review or independent medical examination by a physician who has not treated you
- Obtain a vocational assessment identifying jobs you could theoretically perform, even if those positions do not reflect your real-world circumstances
These are standard steps in the review process. They do not necessarily mean your claim lacks merit. But they do mean it is important to understand what the insurer is looking for and how to respond.
What You Can Do
If your benefits have been denied or terminated at the change of definition stage, you have options. The insurer’s decision is not final.
The most important step is to make sure your medical documentation clearly addresses the any occupation standard. Your doctors should explain not only your diagnosis and symptoms, but specifically how your condition prevents you from sustaining any type of employment on a consistent basis. General statements about being “unable to work” are often not enough at this stage.
It is also worth having a lawyer review your policy and the insurer’s denial letter. There are often issues with how the insurer has applied the definition, assessed the medical evidence, or conducted the vocational analysis. An experienced disability lawyer can identify where the insurer’s reasoning falls short and advise you on the best path forward.
How MacGillivray Law Can Help
Our disability lawyers have been helping Canadians navigate LTD disputes for over 30 years. If your benefits have been denied or cut off at the change of definition stage, we can review your situation and explain your options. There is no cost for the initial consultation.
