Denied Disability: Does Adjuster Says You Can Work?

Published 03/02/2018

In Canada, total disability and any occupation disability are closely related. If you can perform some work but not a comparable job, you may still be considered totally disabled under your policy.

Your disability adjuster says that you can do so “some” type of work. Therefore, you do not suffer a total disability and should not be paid any long-term disability benefits. What are you supposed to think? Generally, you will still be deemed totally disabled if you are only able to take on trivial or inconsequential work, work for which you’re overqualified or work for which you are completely unsuited by way of your background.

What you are doing is comparable to your pre-disability occupation is an issue to be determined on a case-by-case basis. The best way to think about this is in “extremes.” For example, a busy highly skilled plumber would not be forced to greet people walking into a department store. An eye doctor who can only work as a parking attendant will be considered totally disabled from any occupation.

concise-vector
Understand Your Rights Under "Any Occupation" Disability

Denied Long-Term Disability Benefits?

Contact Us Today
total disability and any occupation disability

What if I Am Working but Making Less Money Because of My Disability?

Again, in most cases, the salary of an alternative occupation must be somewhat comparable to your pre-disability occupation. Remember, in most circumstances, an alternative occupation should be reasonably comparable to your pre-disability occupation. Salary is only one of the factors to be considered. The fact that income from your “substitute occupation” might be less than your former job does not really mean that you are disabled under the “any occupation” definition of disability. There are other factors involved if your policy does not mention anything about it.

Also, there are some disability policies that list specific salary “thresholds” which would mention what you can earn at an alternative occupation in order for you not to be considered totally disabled from “any occupation.” Disability Insurance Law in Canada tells us that when an insurance policy is silent, the rule of thumb should be that your alternative job should pay at least 60-66% of their pre-disability salary for you to be considered totally disabled.

A seminal case called Brooks v. London Life tells us that the fact that the income from a substitute occupation may be less than that of the former job does not of itself mean that the substitute job fails to meet the total disability test; it may, however, it may constitute a factor to be considered when applying that test.

What if I Can Only Do Work of Insubstantial Nature?

If the new job you are doing is considered insubstantial, you will normally not be disqualified from receiving your long-term disability benefits. For example, in the case of Walls v. Constellation Insurance – a construction project manager was found to be disabled pursuant to his long-term disability policy (from any occupation) when pain from a heart surgery scar made it too hard for him to perform any type of intellectually challenging work on a full-time basis, even though he was able to golf and drive a car. He needed to avoid stressful situations.

“Any occupation,” as defined in most long-term disability policies, usually requires that the insured person be prevented from engaging in any occupation or performing any work for compensation or profit. However, with all this in mind, the situation should be considered on a case-by-case basis.

The fact that you may be able to work at a comparable type of job but make less money, work fewer hours, or whether or not you can perform some work of an insubstantial nature are all factors that should be determined when considering whether or not you are totally disabled.

A Court will look at your physical condition, your age, your medical condition, your education, your work experience, any courses that you have taken, your functional tolerances, your physical intolerances, your emotional and mental intolerances and your day-to-day activities to determine whether or not you would be able to succeed in some type of work activity.

Overall, we would say that a person is totally disabled from engaging in ‘any’ occupation if his or her condition prevents him or her from entering into an occupation reasonably comparable to his or her old occupation in status and reward, and reasonably suitable in work activity in light of his or her education, training and experience – but every case should certainly assessed and/or decided on their own facts.

I highly recommend Lalande Personal Injury Lawyers legal team. Matt Lalande and his team are caring, compassionate and patient. From our first appointment to the last, we always knew what to expect and were encouraged to ask as many questions as needed. Matt’s knowledge, experience and professionalism is outstanding. He is also very friendly, kind and relatable. Sarah was a pleasure to work with – always so friendly, helpful and available. Their clear communication, during our difficult situation, made things less stressful. We are thankful to have had them on our side. – Kristy Sarrazin

Get the Legal Support You Need for Your Long-Term Disability Claim

If you’ve been denied long-term disability benefits or are struggling with the complexities of your insurance claim, it’s crucial to have an experienced disability lawyer by your side. A qualified lawyer will help you understand your rights under “total disability and any occupation disability” policies, ensuring you receive the benefits you’re entitled to.

Call us at 905-333-8888 or fill out our confidential contact form here for a free consultation. Let us help you navigate the claims process and secure the financial support you deserve.

Article FAQs

What is the definition of "any occupation" in long-term disability policies?

“Any occupation” refers to a person being unable to perform any work for compensation or profit due to their disability. If you cannot perform a comparable job to your previous occupation, you may still qualify as totally disabled.

If I can work but earn less money, am I still considered disabled?

If your alternative job pays less than your pre-disability occupation, it doesn’t automatically mean you are not disabled. Your disability insurance policy might require your substitute job to pay at least 60-66% of your former salary.

What if I can only do work of an insubstantial nature?

If you can only perform a trivial or insubstantial job, you may still be considered totally disabled, especially if the work does not align with your qualifications, experience, or prior earnings.

How does a court determine whether I am totally disabled?

Courts will assess your physical condition, age, medical condition, education, work experience, and other factors to determine if you can perform a job comparable to your previous occupation in terms of status and reward.

What case examples demonstrate "any occupation" disability?

In the case of Walls v. Constellation Insurance, the court ruled that a construction project manager who couldn’t perform intellectually challenging work due to pain from heart surgery was considered totally disabled under his long-term disability policy.