Our Top BC disability lawyers provide detailed guidance on how long-term disability benefits may end in British Columbia, covering reasons like policy changes, medical evaluations, and non-compliance. We help clients navigate these complex situations and challenge wrongful terminations of their benefits. With our expertise, we work to protect your rights and ensure you receive the financial support you deserve. Contact us for a free consultation if your benefits have been unfairly cut off.
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 British Columbia long-term disability lawyers can help with—please contact us for more information.
However, once individuals receive benefits, many have the same question: How long will these benefits last? The short answer is that it’s different for everyone. Not only are policies different from each other, but so are people and their circumstances.
There are various circumstances in which your long-term disability benefits can and will be terminated, regardless of your involvement or actions. The distinction between ‘can’ and ‘will’ is crucial here, as it highlights the difference between potential outcomes and guaranteed ones, emphasizing the importance of understanding your rights and options in the event of a termination.
Long-term disability (LTD) benefits are designed to provide financial support to individuals who cannot work due to a serious injury or illness. Unlike short-term disability or Employment Insurance (EI) sickness benefits, LTD benefits offer extended coverage, often lasting for years, depending on the policy terms. While short-term disability and EI typically cover temporary conditions for a limited period, LTD benefits are intended for long-term or permanent disabilities that prevent you from working in any capacity.
To qualify for LTD benefits, claimants must demonstrate that they have a “total disability,” which means they cannot perform the essential duties of their occupation, and after two years, they must prove they are unable to perform the duties of any occupation for which they are reasonably suited. These benefits are typically provided through private insurance policies obtained through employers or purchased individually. The amount paid is often a percentage of the claimant’s pre-disability income, generally between 60% and 70%.
Benefits are calculated based on your salary before your disability and paid monthly. To obtain LTD benefits, claimants must submit a detailed application, including medical documentation from healthcare providers, and meet their insurance company’s specific criteria. Unfortunately, many claims are denied, often requiring legal assistance to challenge the insurer’s decision.
When Your Disability Insurer…Terminates Your Benefits – Unfortunately, this may happen if your insurer determines you no longer meet the policy’s definition of “total disability.” This decision can stem from tests they require you to undergo, surveillance they conduct, or an assertion by the insurance adjusters that you can work in some capacity.
A common point at which long-term disability insurers in British Columbia terminate benefits is after two years when the definition of total disability changes.
For the first two years of a long-term disability policy, the ‘own occupation’ definition generally applies. This means that to qualify for benefits, you must be unable to perform the essential duties of your current job, even with reasonable accommodations from your employer. If your condition prevents you from fulfilling these responsibilities, you may meet the definition of being ‘totally disabled’ under your policy.
After two years, most policies move to the “any occupation” definition, which you must meet to continue receiving benefits. At this point, you must prove that you cannot perform the core tasks and duties of any job for which you are reasonably qualified based on your skills, experience, and education.
Many claimants experience wrongful termination of benefits at this unfortunate two-year junction. Insurers often use this change in definition to argue that the claimant can do “some form of work” despite their healthcare providers maintaining that they are not fit to return to any occupation. In reality, many disability adjusters do not adequately understand the contractual policy definitions and, as such, end up wrongfully terminating the long-term disability payments of claimants when they should not have.
Our long-term disability lawyers in British Columbia are well-versed in litigating the contractual challenges with the change of definition and navigating the complexities of proving ongoing disability under the more stringent “any occupation” criteria. 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.
Other situations in which your long-term disability benefits may end in British Columbia include:
Failing to communicate with your LTD carrier: If you fail to update your disability insurer on your condition, fail to provide required medical evidence, fail to answer their questions, etc, they may terminate your benefits.
Failing to participate or cooperate in a medical treatment or rehab plan: Many policies state that to qualify for long-term disability benefits, you must participate in a treatment plan to help mitigate your condition. Failure to cooperate with rehabilitation or treatment plans can be seen as a lack of desire to recover. Lack of treatment also means recovery becomes delayed or impossible, thus creating an endless need for benefits. However, some limits to this, set out by our Courts, are essential to know and understand.
Failure to follow medical advice: If you are not adhering to prescribed medical treatments or refuse recommended rehabilitation, your insurer may terminate benefits.
Failure to provide ongoing medical evidence: Most insurers require regular updates and medical documentation to ensure you still cannot work. Your benefits could be suspended or terminated if you do not provide this evidence.
Substance abuse or addiction: Some policies exclude disabilities resulting from substance abuse or addiction unless you are participating in an approved rehabilitation program. If you refuse treatment, benefits may be terminated. Again, there are some limits to this, set out by our Courts, which are essential to know and understand.
Refusal to participate in rehabilitation or vocational programs: Some insurers offer rehabilitation or vocational training programs to help you return to work. However, they may terminate your benefits if you refuse to participate without valid medical reasons. These programs are designed to help claimants re-enter the workforce, and declining them could be viewed as a lack of effort to recover. Again, there are some limits to this, set out by our Courts, which are essential to know and understand.
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 you can make specific arrangements with the insurer. Again, there are some limits to this, set out by our Courts, which are essential to know and understand.
Fail to apply for collateral benefits: Failing to apply for or appeal denials of other disability benefits, such as CPP Disability, could be viewed as non-compliance with policy requirements.
Your LTD will End in British Columbia When you are no Longer Disabled.
If you fully recover from your injury or illness, you may no longer meet the definition of “total disability” under your long-term disability (LTD) policy. Your eligibility for LTD benefits will change as your health improves and you regain the ability to work.
Long-term disability benefits are intended to support you financially while you cannot perform the essential duties of your own occupation and, later, any occupation for which you are reasonably suited by way of your education, training and experience. Once you can reasonably and safely return to work, either in your previous job or a new one for which you are suited, you will no longer be entitled to LTD benefits.
You’ve Turned 65: LTD benefits end once you reach the maximum benefit period, often age 65. At this point, the terms of most LTD policies no longer provide coverage, as you have reached the age when you most commonly retire.
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 can no longer participate in the workforce.
If you Hurt Yourself: If you intentionally hurt 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 and return to work. In this case, they may interpret this behaviour as non-compliance with the objective of rehabilitation and terminate your benefits.
If you return to work: If you return to work in any capacity, either part-time or full-time, the insurer may determine that you are no longer totally disabled. This is particularly possible 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, your claim can be denied or your benefits terminated. This is true whether you’re in the application stage or already in the benefits period. Insurers may conduct investigations and deny claims based on evidence contradicting 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. They also hold claimants accountable for taking reasonable steps toward recovery.
The termination of long-term disability benefits in British Columbia, regardless of the reason, can have far-reaching consequences for claimants. The potential for benefits to be cut off creates a profound sense of uncertainty, contributing to heightened anxiety and financial instability for individuals already grappling with the challenges of a disabling condition.
Understanding the mechanisms by which benefits may be discontinued and preparing for the possibility is essential in mitigating the emotional and financial toll. Nonetheless, the abrupt loss of support can deeply impact an individual’s ability to manage their health, livelihood, and future security, underscoring the importance of careful navigation through the legal and procedural landscape of disability policies.
IIf your long-term disability benefits have been wrongfully terminated, our experienced disability lawyers are here to help. Since 2003, we have successfully assisted claimants across Canada whose benefits have been unfairly stopped or denied. Please don’t hesitate to reach out to us at 1-844-4-Disability or send a confidential email through our website. We’ll arrange a free, no-obligation consultation to explain your disability rights and legal options. Remember, you won’t pay any legal fees unless we win your case.
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LTD benefits typically last until you’re no longer disabled or until the maximum benefit period, often age 65.
Total disability means you are unable to perform your job’s essential duties and, after two years, any job for which you’re qualified.
Yes, after two years, the definition shifts to “any occupation,” and benefits may stop if you’re able to work in another role.
LTD benefits are typically a percentage of your pre-disability earnings, usually between 60% and 70%.
Contact a disability lawyer to review your case and potentially appeal or litigate the decision.
Yes, some policies have geographic restrictions, and moving outside the coverage area can result in the termination of benefits.
“Own occupation” applies for the first two years, after which “any occupation” requires that you cannot work in any job you’re suited for.
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Patricia Williamson
Long-Term Disability
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Long-Term Disability
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Long-Term Disability
