Virtually every group LTD policy uses two sequential disability definitions. For the first 24 months, disability is assessed by reference to the claimant’s own pre-disability occupation. After 24 months, a stricter definition applies: whether the claimant can perform the essential duties of any occupation for which they are reasonably suited. This transition is predictable, planned, and must be prepared for well in advance.
Under own occupation, a claimant is disabled if unable to perform the substantial duties of their specific pre-accident job — not some other role. A cardiovascular surgeon who can no longer operate due to hand tremors is disabled even if capable of administrative medical work. The focus on the specific occupation makes this standard relatively claimant-friendly.
After 24 months, insurers evaluate whether the claimant can perform the essential duties of any occupation for which their education, training, and work experience reasonably suit them. Vocational assessors identify sedentary roles in the labour market and use those identifications to justify termination.
Prepare well in advance: The 24-month transition is entirely predictable. Build the “any occupation” evidentiary record at least six months before the definition changes. Functional capacity evaluations, comprehensive specialist reports, and detailed occupational histories are essential.
Ontario courts have consistently rejected insurer positions that treat “any occupation” as any conceivable sedentary role regardless of earnings, availability, or realism. The occupation must be one the claimant could realistically obtain given actual skills, age, geographic location, and the real labour market. Courts have rejected arguments that a severely impaired professional could transition to minimum-wage employment.