Many rely on long-term disability benefits to pay their bills and keep themselves afloat while they cannot work. Long-term disability benefits are paid to those determined to have a “total disability.” This requires individuals to be deemed disabled not only by their medical caretakers but also by their insurance companies. This can be a long process that our Alberta long-term disability lawyers can help with—please contact us for more information.
However, once individuals receive benefits, a common question arises: How long will these benefits last? The short answer is that it varies. Not only are policies different from each other, but so are people.
Certain situations, many of which are out of your control, will result in the end of your long-term disability benefits. However, other scenarios, sometimes within an individual’s control, can result in the end of benefits if specific criteria are met.
Our Alberta disability lawyers can better explain these details during a free consultation should you have specific questions or want advice about your circumstances.
There are a variety of scenarios wherein your long-term disability benefits will end without your action or input. Some decisions are reversible, while some are not.
Unfortunately, this situation may arise if your insurer determines that you no longer meet the policy’s definition of “total disability.” This assessment can stem from tests they require you to undergo, surveillance they conduct, or an assertion by their adjusters that you can work in some capacity.
A common point at which long-term disability insurers terminate benefits is the two-year mark, when the definition of total disability shifts from “own occupation” to “any occupation.”
The “own occupation” definition typically applies for the first two years of benefits. During this period, to be considered totally disabled, you must be unable to perform your current job’s substantial duties, even with reasonable accommodations.
After two years, most policies adopt the “any occupation” definition. At this stage, to continue receiving long-term disability benefits, you must demonstrate that you cannot perform the essential tasks and duties of any job for which you are reasonably qualified based on your skills, experience, and education. For example, a construction worker with a permanent back injury may be incapable of physical labour but could perform an office or administrative role in the same industry. Under the “any occupation” definition, you may no longer qualify for long-term disability benefits.
Unfortunately, many claimants experience wrongful termination of benefits at this two-year junction. Insurers often leverage the change in definition to argue that the claimant can perform some form of work, even when the individual and their healthcare providers maintain that they are not fit to return to any occupation.
Many individuals – and even their doctors – are surprised at this stage, believing they still meet the criteria for disability benefits. In their distress, many often attempt to appeal the decision, hoping it was a mistake, only to face further denial and delay.
Our long-term disability lawyers in Alberta are well-versed in handling such cases. We can assist you in gathering the necessary medical evidence to demonstrate that you remain disabled under the policy’s terms. Our goal is to build a strong case to secure a fair resolution, whether that be through a reinstatement of benefits or a fair settlement.
When you recover from your injury or illness, you may no longer meet the definition of “total disability” under your long-term disability (LTD) policy. As your health improves and you regain the ability to work, your eligibility for LTD benefits changes. These benefits are intended to support you financially while you are unable to perform the essential duties of your own occupation, and later, any occupation for which you are reasonably qualified. Once you can return to work, whether it’s in your previous role or another suitable job, you will no longer be entitled to LTD benefits.
Your insurer will typically assess your recovery through medical evaluations and reports from your healthcare providers. They may also ask for proof that your condition has improved enough for you to return to work. While losing your LTD benefits might feel like a significant change, it’s a sign that you have reached a positive point in your recovery. You no longer need the financial support because you’re now able to work and earn an income again, marking a big step forward in your journey.
While recovery from an injury or illness is one of the most common reasons for long-term disability (LTD) benefits to cease, there are several other circumstances in which your benefits may also come to an end.
You’ve Turned 65: LTD benefits typically end once you reach the maximum benefit period, which is often when you turn 65. At this point, the terms of most LTD policies no longer provide coverage, as the individual has reached the age commonly associated with retirement.
If you go to Jail: If you are incarcerated, your LTD benefits will be terminated. Most policies include provisions that suspend or end benefits if the claimant is imprisoned, as they are no longer available to participate in the workforce.
If you Hurt Yourself: If you intentionally harm yourself and cause injury, your LTD benefits may also be terminated. Insurers view self-inflicted harm as an indication that you are not making a good-faith effort to recover or return to work. In such cases, they may interpret this behavior as non-compliance with the objective of rehabilitation and end your benefits.
If you go back to work: If you return to work in any capacity, whether part-time or full-time, the insurer may determine that you are no longer totally disabled, which can lead to the discontinuation of benefits. This is particularly true if your earnings exceed a certain threshold set by the policy.
If you lied or falsified information: If you are found to have misrepresented your condition, either when applying for LTD benefits or during the benefit period, your claim can be denied or your benefits terminated. Insurers conduct investigations and may deny claims based on evidence that contradicts your statements or actions.
Each of these scenarios reflects the insurer’s position that LTD benefits are meant to support claimants who are unable to work due to their health while also holding claimants accountable for taking reasonable steps toward recovery.
Conversely, some circumstances can end your long-term disability benefits, but only if you allow these things to happen. This is where it’s important and helpful to work with an Alberta long-term disability lawyer. They guide you through the process, ensure compliance, and help you prevent mistakes.
Some of these situations include:
Failing to communicate with your LTD carrier: If you fail to update the insurer on your condition, fail to provide required medical evidence, fail to answer their questions, etc, they can terminate your benefits.
Failing to participate or cooperate in a medical treatment or rehab plan: Failure to cooperate with treatment or rehab can be seen as a lack of desire to get better. Lack of treatment also means recovery becomes delayed or impossible, thus creating an endless need for benefits.
Failure to Follow Medical Advice: If a claimant is not adhering to prescribed medical treatments or refuses recommended rehabilitation, an insurer may terminate benefits. LTD policies often require that claimants make reasonable efforts to recover, and failure to do so can result in loss of benefits.
Failure to Provide Ongoing Medical Evidence: Most insurers require regular updates and medical documentation to confirm that you are still unable to work. If you fail to provide this evidence, your benefits could be suspended or terminated.
Substance Abuse or Addiction: Some policies exclude disabilities resulting from substance abuse or addiction unless the claimant is participating in an approved rehabilitation program. If an individual refuses treatment, their benefits may be terminated.
Refusal to Participate in Rehabilitation or Vocational Programs: If your insurer offers rehabilitation or vocational training programs to help you return to work and refuse to participate without valid medical reasons, your benefits may be terminated. These programs are designed to help claimants re-enter the workforce, and declining them could be viewed as a lack of effort to recover.
Relocation to a Different Jurisdiction: With some policies, moving to another country may impact your ability to receive LTD benefits. Certain policies have geographic restrictions, and moving out of the coverage area can result in a loss of benefits unless specific arrangements are made with the insurer.
Fail to Apply for Collateral Benefits: Failing to cooperate in applying for or appealing denials of other disability benefits, such as CPP Disability, could be viewed as non-compliance with policy requirements.
If you’ve been wrongfully denied long-term disability benefits in Alberta, we understand the uncertainty and stress this can cause. At Lalande Disability Lawyers, we focus on helping clients navigate the complexities of insurance disputes to recover the benefits they’re entitled to.
Our skilled lawyers are dedicated to building a solid case supported by expert medical evidence and negotiating on your behalf with the insurance companies. With a compassionate and results-driven approach, we’re here to support you every step of the way.
Since 2003, we’ve been helping claimants whose disability benefits have been stopped or denied. Please don’t hesitate to call us, no matter where you are in Canada, at 1-844-4-Disability or send us a confidential email through our website – and we’ll set up a meeting to explain disability rights and legal options at no cost to you. Remember, our consultations are 100% free, and if we work together, you don’t pay legal fees unless we win your case.
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LTD benefits generally end when you reach the maximum benefit period, which is typically at age 65. However, benefits may also cease if you recover from your condition or are no longer considered totally disabled.
Yes, if your health improves and you are able to return to work, your LTD benefits will likely end, as you no longer meet the policy’s definition of total disability.
Most LTD policies in Alberta have a maximum benefit age of 65, meaning your benefits will generally stop once you reach this age, even if you remain disabled.
Yes, LTD benefits can be terminated for reasons such as incarceration, self-inflicted injuries, or non-compliance with treatment or rehabilitation programs.
If you believe your benefits were wrongfully terminated, it’s important to consult a disability lawyer to help challenge the decision and ensure your rights are protected.
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Patricia Williamson
Long-Term Disability
“Matt Lalande helped me attain my long-term disability benefits. The denial of benefits caused me substantial stress on top of my existing condition. Matt Lalande and his team were very understanding and explained the whole process clearly. They were confident that we would be successful. Dealing ...
Cheryl Oddie
Long-Term Disability
My experience with Mr. Matt Lalande and his team was exceptional. Matt is a very impressive professional when involved in a long-term disability benefits denial. Matt and Heather responded to all my emails and phone calls in a prompt and efficient manner. Matt is a great and honest lawyer. I highly reco...
Payne Momich
Long-Term Disability
