By Matt Lalande in Long-Term Disability on December 20, 2023
The answer of course and as always – is that it depends.
If you are receiving long-term disability benefits from Manulife for two years, it is possible that Manulife can stop payment of benefits if you do not meet the definition of long-term disability as set out in your disability policy.
This piece aims to shed light on a common query among policyholders: why are many disability claims terminated at the two-year mark? Understanding this aspect is crucial for anyone navigating the complex landscape of disability benefits, especially those who are approaching or have reached this critical juncture in their claim.
The two-year mark in Manulife disability insurance policies is often a turning point, where the criteria for benefit eligibility undergo a significant change. This transition, a standard feature in many long-term disability policies, including those offered by Manulife, can be a source of confusion and concern for claimants. Our discussion will explore the shift in policy definitions that occurs at this stage and its implications for policyholders. Our Hamilton long-term disability lawyers aim to provide clarity and insight, helping you understand the rationale behind these changes and how they might affect your claim.
As you approach the two year mark, Manulife will be taking a hard look at whether you fit into your policy’s changing definition of “total disability” and it will be much harder to qualify for long-term disability benefits.
Total disability – after two years – is typically defined in Manulife disability policies by way of two criteria. The insurance company sets-out the first criteria as called “own occupation” while the second is called “any occupation.” The differences are substantial.
Under the “own occupation” provision, an individual is considered totally disabled if they are unable to perform the substantial duties of their own particular job due to an illness or injury. This definition focuses solely on the claimant’s ability to carry out the functions of the job they held at the time of becoming disabled. It’s a less onerous test to meet compared to the “own occupation definition” as it does not require the claimant to be incapable of performing any work whatsoever. Instead, it acknowledges the unique aspects of an individual’s job, allowing for a more personalized and fair assessment of their disability status.
Then, at the 2 year mark, no matter if you suffer from a mental health condition, cancer, a heart condition, a chronic illness,an auto-immune disorder or chronic pain due to a serious injury or with any other health conditions – Manulife will start assessing your claim in a more complex way and redetermine whether your disability prevents you from working.
The test at the two year mark changes from your “own occupation” to “any occupation” which means that you must be unable to perform the duties of any job for which you are reasonably qualified by education, training, or experience. This change of definition makes it harder to individuals to qualify for long-term disability after two years.
For example, if a dentist develops a hand tremor and can no longer perform dental surgery, they might be considered disabled under an “own occupation” definition, even if they are still capable of working in other capacities or jobs as a dentist. The “own occupation” period in a policy often applies for a limited time (e.g., the first two years of disability), after which the policy might switch to an “any occupation” definition. But what happens if that same dental surgeon suffers from debilitating depression and mental health difficulties?
He/she might not be able to sustain the demands of “any employment” in the medical field if that surgeon becomes unreliable in terms of attending to a regular patient schedule.
This definition is crucial because it often determines how easily a claimant can qualify for LTD benefits. Policies with an “own occupation” definition are generally more favorable to the insured, especially for professionals with specialized skills or demanding jobs.
This redefinition can feel like moving goalposts and has led many insurers — including Manulife — to reassess claims with an eye towards reducing their financial liability and paying claims. It’s at the two year mark that Manulife will tend to terminate benefits of many disability claimants – often thinking that because there’s no objective medical evidence, there’s “something” that the claimant can do – which is certainly, not always the case.
The reality is that sometimes people suffering may not be able to prove total disability on their own. You may need the assistance of a long-term disability lawyer to help you meet Manulife’s definition of total disability at the two year mark. Remember – claimants who’s disability benefits have been cut-off at the two-year point have the burden of proving total disability.
In building a case to meet the burden of total disability, our long-term disability lawyers will gather and analyze a substantial amount medical evidence – often stemming back years – to demonstrate our clients’ ongoing disability and why it started – and need for financial benefits, often liaising with medical professionals to obtain detailed reports and assessments.
In building a case, our disability lawyers will also scrutinize the reasons provided by Manulife for the termination of benefits and challenge any unfounded or erroneous conclusions. This often involves a detailed examination of Manulife’s adherence to procedural fairness and the accuracy of their assessment. Our disability lawyers will prepare and file necessary legal documents, represent our clients in negotiations with Manulife, and, if necessary, litigate the case in court.
When a claimant is denied long-term disability benefits, opting to hire a experienced disability lawyer and initiate legal action for wrongful denial of benefits can be more advantageous than filing an internal appeal through the appeals process with Manulife.
This is because internal appeals, even when provided new supporting evidence, are reviewed by other employees at the insurance company – the same insurance company that initially denied your claim, potentially leading to a bias in favor of maintaining their original decision.
An experience insurance disability lawyer, on the other hand, brings specialized legal expertise and experience in disability law, which is crucial for effectively navigating legal definitions and complexities of such cases. Our Hamilton disability lawyers are adept at gathering necessary medical evidence, securing expert opinions, and assembling relevant documentation to help you build a stronger case.
Also,the mere initiation of lawsuit in itself can often provide significant leverage against insurance companies, who may at some point (assuming you have the right lawyer) prefer to offer a fair settlement rather than engage in a costly and time-consuming legal battle.
Furthermore, engaging an experienced disability lawyer helps ensure that all actions are taken within the appropriate legal timeframe, thus avoiding the risk of missing critical deadlines due to prolonged internal appeals. Additionally, lawyers specializing in this field have a deep understanding of the claimant’s legal rights and entitlements, ensuring that they receive the full Manulife disability benefits they are legally entitled to.
If Manulife has terminated your long-term disability benefits you still have rights. You still have the right to hire your own disability lawyer to assist and provide evidence confirming your disability to the insurer or in the alternative, to start a lawsuit on your behalf for the wrongful termination of your benefits benefits.
We understand that the abrupt termination of long-term disability benefits can plunge individuals into a state of stress and uncertainty, both financially and emotionally. Moreover, the process of dealing with insurance adjusters, for many, often adds an additional layer of serious mental distress. The interaction with Manulife adjusters can often be exhausting, requiring a level of expertise and energy that someone grappling with illness or disability may not have. The uncertainty and complexity of navigating these bureaucratic processes, often characterized by a lack of clear communication and support, can lead to feelings of helplessness and frustration. We understand everything you’re going through.
If you think you need a disability lawyer, you probably do.
If Manulife has stopped paying your disability benefits at the 2 year mark, call us today. We are here to help you secure the disability benefits you deserve so that you can focus on your recovery without added financial burdens. Our experienced disability lawyers have successfully represented thousands of clients, and we look forward to helping you.
Benefits can paid until the age of 65 in most cases.
Disability benefits often stop after two years due to the ‘change in definition’ clause in most insurance policies. This clause shifts the criteria from being unable to perform your own job to being unable to perform any job you’re qualified for, based on education and experience. Understanding this policy change is crucial for those relying on long-term disability benefits
If your disability benefits are discontinued after two years, it’s important to review your insurance policy’s terms. Often, the stoppage is linked to a policy clause. Seeking legal advice or consulting with a disability advocate can provide guidance on how to appeal the decision or explore alternative support options.
The two-year limit on disability benefits is a common policy feature, reflecting a shift in the definition of disability. Initially, benefits are granted if you can’t do your specific job, but after two years, the criteria change to being unable to perform any job. Awareness of this policy is key for long-term planning.
Preparing for the two-year disability benefit review involves gathering comprehensive medical evidence and understanding your policy’s definition of disability. Proactive planning and consultation with a disability benefits expert can improve your chances of successfully extending your benefits beyond the two-year mark.