What happens after two years on long-term disability in Ontario?

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In Ontario, long-term disability (LTD) benefits provide a vital financial lifeline for individuals unable to work due to serious injury or illness, helping maintain a stable income when health issues prevent them from earning a living. Most insurance policies define who qualifies as “totally disabled” — and for the first two years, that means you can’t perform the duties of your job.

However, as you approach the two-year mark, the insurance company will usually apply a stricter definition of “total disability.” Instead of considering whether you can do your current job, they assess whether you can do any job for which you are reasonably qualified.

This shift — known as the “change of definition” — often leads to reassessments, potential denials and uncertainty for claimants. Understanding how “total disability” is redefined at this stage is crucial to protecting your benefits.

‘Own Occupation’ vs. ‘Any Occupation’

During the first two years of your LTD claim, insurers generally assess whether you can perform the essential duties of your own job.

If a medical condition prevents you from performing your job, you typically qualify for LTD benefits during this period. This is often referred to as the “Own Occupation” test, and focuses on whether you can complete the specific responsibilities of your current role.

After two years, most policies shift to the “Any Occupation” test — a much stricter standard. At this stage, your insurer applies a tougher definition of what it means to be “totally disabled.”

Instead of focusing on your own job, insurers require proof that your medical condition prevents you from performing any job for which you are reasonably qualified based on your skills, education or work experience.

As Sivan Tumarkin, national co-managing partner at Samfiru Tumarkin LLP, explains, “Understanding your disability rights is crucial. Facing an insurance company can feel like David battling Goliath. They have vast resources and often deny disability claims to protect their profits.”

At this point, your insurer may deny your benefits if they believe you could do a different job — one that may be less demanding or that you are theoretically qualified for.

To continue receiving benefits, you must show that your disability prevents you from doing any occupation that provides you with at least 60 per cent of your pre-disability income.

What happens at the two-year mark?

For many individuals on LTD, the two-year mark brings increased scrutiny from their insurer. Here’s what typically happens:

1. Reassessment of the claim: The insurance company will often conduct a medical review and vocational evaluation to determine whether the claimant still meets the definition of “disability” under the “Any Occupation” test.
2. Increased risk of denial: If the insurer believes the claimant is capable of doing any job — even one that might pay less than their previous position — they may cut off access to LTD benefits. This is one of the most common points of denial, as insurers try to minimize payouts and maximize profits.
3. Importance of medical evidence: Strong medical documentation is key. Treating doctors must provide clear evidence that the claimant’s condition still prevents them from working. Without it, the insurer may deny the claim.

“At the two-year mark, insurers often reassess claims and may push you to return to work prematurely — prioritizing their financial interests over your health and well-being,” says Tumarkin.

“We’ve seen insurers deny even the most obvious claims, like in the case of Mitch Murphy, where they refused to recognize a paraplegic man as ‘totally disabled.’ If they’ll deny someone in that position, they’ll deny anyone if they think they can get away with it.”

Protecting your benefits: What you can do

The risk of being cut off LTD after two years is a reality that many people face, but there are steps you can take to protect your access to disability benefits:

• Consult with a disability lawyer: If you are approaching the two-year mark or have already been cut off benefits, it’s crucial to speak with a disability lawyer. Samfiru Tumarkin LLP offers free consultations to help you navigate the complex and often challenging process of appealing a denial or protecting your right to LTD benefits.
• Don’t rush back to work: If your doctor advises against returning to work, follow their guidance. Going back too early could jeopardize your claim, and more importantly, your health.
• Be aware of surveillance: Insurance companies may monitor your activities to look for reasons to deny your claim. Don’t feel pressured to follow any requests from your insurer without first consulting your doctor or a lawyer.

When evaluating your long-term injury, illness or medical condition, support from your treating doctor is critical.

According to Tumarkin, “If your doctor says you can’t return to work, your benefits should continue. If your insurance company denies your LTD claim despite proper medical documentation, reach out to me for a free consultation. My team can provide the right knowledge and support to level the playing field.”

• READ MORE: Long-term disability denied? 3 things employees need to do

What to expect after denial

If your LTD benefits are cut off after the two-year mark, it’s not the end of the road. Here’s what you can do:

1. Review the denial: Carefully analyze your insurer’s reasoning. Many claims are cut off based on vague or incomplete information.
2. Gather medical evidence: Ensure you have comprehensive medical documentation from your treating doctor and specialists. Strong evidence is crucial in proving that your condition prevents you from working.
3. Seek legal help: The appeals process can be complicated and is often a waste of time, but a lawyer experienced in LTD claims can make all the difference. Samfiru Tumarkin LLP has helped thousands of clients successfully challenge unfair LTD denials. They know the tactics insurers use to deny claims and are here to help you fight for the benefits you deserve.

Final thoughts: Protecting your financial future

As you approach the two-year mark on long-term disability benefits in Ontario, it’s essential to understand the shift from the “Own Occupation” test to the “Any Occupation” test.

Insurers often use this transition as an opportunity to deny benefits, but you have legal options to protect your financial future.

• READ MORE: Can you be fired while on long-term disability in Ontario?

Tumarkin emphasizes that with the right legal strategy, his firm consistently turns the tide in the claimant’s favour.

“Insurance companies deny claims to protect their bottom line, not because it’s the right decision. But we know their game inside and out. Some of the lawyers on my team used to work for insurance companies, so we know exactly how they operate, and more importantly, how to beat them at their own game.”

If your insurer is threatening to cut off your benefits or has already denied your claim, don’t go through this alone. Contact Samfiru Tumarkin LLP for a free consultation.

Recognized as Canada’s leading disability law firm, Samfiru Tumarkin LLP provides a range of resources to help clients understand their legal rights. These include the Disability Law Show, online LTD FAQs and free consultations.

If your LTD benefits have been denied or cut off, contact Sivan Tumarkin and his team to explore your options and protect your right to the support you need. For a free LTD consultation, call 1-855-821-5900 or email help@disabilityrights.ca to receive prompt, personalized guidance from a qualified long-term disability lawyer.