What Really Happens When LTD Shifts from “Own Occupation” to “Any Occupation”

For many people receiving long-term disability (LTD) benefits, the most difficult stage of the claim does not happen at the beginning. It happens later—usually around the two-year mark—when the insurance company says the definition of disability has changed.

This moment is commonly referred to as the “change of definition,” the 24-month change, or the shift from “own occupation” to “any occupation.” It is also one of the most common points at which LTD benefits are terminated, even where a person’s health has not meaningfully improved.

If you are receiving LTD benefits in Ontario, understanding how this transition works—and how insurers approach it—is critical. In this article, I’ll explain what the change of definition really means, the tactics insurers commonly use at this stage, and what you can do to protect your claim before and after the definition changes.

What is the “change of definition” in an LTD claim?

Most group LTD policies in Ontario define disability in two stages. If you’re unfamiliar with this structure, you may want to start with our overview, Your Roadmap to Long-Term Disability Claims in Ontario.

The first stage: “Own occupation”

For an initial period—most often the first 24 months—you are considered totally disabled if you are unable to perform the essential duties of your own occupation, meaning the job you were doing when you became disabled.

At this stage, the question is relatively straightforward:
Can you do your job?

The second stage: “Any occupation”

After that initial period, the definition becomes more restrictive. To continue receiving benefits, you must usually show that you are unable to perform the essential duties of any occupation for which you are reasonably suited by education, training, or experience.

This shift dramatically changes how insurers assess your claim and is one of the most common triggers for benefit terminations.

“Any occupation” does not mean any job at any income

One of the most common misconceptions about LTD claims is that “any occupation” means any job at all. That is not correct.

In most LTD policies, the alternative occupation must be gainful. Some policies define gainful directly. Others do not—but where the policy is silent, courts have generally interpreted “gainful” to mean work that provides a commensurate income.

In practical terms, this often means:

• income comparable to the LTD benefit amount, or
• approximately 60–70% of indexed pre-disability earnings.

Insurers frequently gloss over this requirement. They may identify low-paying or marginal roles and argue that the mere existence of those jobs defeats entitlement. A job that does not meet the income threshold required by the policy—or recognized by the courts—may not satisfy the “any occupation” test at all.

Why the change-of-definition stage is so risky for claimants

The 24-month mark is one of the most dangerous points in an LTD claim. Even if your condition has not improved, insurers often treat this stage as an opportunity to reassess long-term exposure.

At or around this point, insurers commonly:

• increase medical requests,
• schedule insurer-arranged examinations,
• initiate vocational or functional assessments,
• introduce rehabilitation or return-to-work programs,
• request CPP Disability applications,
• conduct surveillance,
• or terminate benefits shortly after the definition changes.

Many people are caught off guard, especially when they have been receiving benefits without issue for years.

What insurers are really focused on: function

Although insurers often say they are reviewing “medical evidence,” what they are actually assessing is function.

Their real questions are:

• What can you do?
• For how long?
• How often?
• How reliably?
• And can you sustain that level of function in regular, gainful employment?

This is why insurers may accept that you have a diagnosis but still say you are not disabled. Disability insurance is not about labels—it is about functional capacity in the workplace.

Common insurer tactics at the change-of-definition stage

Tactic #1: “You can do some work, therefore you are not disabled”

Insurers frequently argue that because a person can perform some tasks, they can work.

This ignores the reality that disability is about sustainability. Being able to complete isolated activities—or work briefly on a good day—is not the same as being able to:

• attend work consistently,
• maintain pace and productivity,
• manage symptoms over time,
• and meet employer expectations without repeated breakdowns.

Tactic #2: Ignoring the income requirement tied to “any occupation”

Insurers often identify alternative jobs without properly analyzing whether those jobs are gainful.

They may rely on:

• theoretical wage data,
• outdated labour statistics,
• or jobs that do not realistically exist for someone with your limitations.

If the income is not commensurate with the policy requirements, the job may not meet the “any occupation” definition—even if it sounds plausible on paper.

Tactic #3: Insurance-sponsored rehabilitation and return-to-work programs

As the change-of-definition date approaches, insurers often introduce rehabilitation or return-to-work (RTW) programs.

These programs are often presented as supportive, but they are typically insurer-driven and closely tied to claim management strategy.

Common issues include:

• rehab plans that move faster than medical recovery supports,
• vocational assessments that emphasize theoretical capacity rather than real-world function,
• pressure to attempt work despite ongoing symptoms,
• documentation that is later relied on to justify termination.

Participation in rehab does not automatically mean you are capable of “any occupation,” but insurers often treat it that way. Even unsuccessful or short-lived attempts can be framed as evidence of work capacity.

Tactic #4: “There is insufficient objective medical evidence”

At the change-of-definition stage, insurers often claim there is not enough “objective” evidence to support ongoing disability.

This is especially problematic for people with:

• chronic pain,
• fatigue-related conditions,
• mental health disabilities,
• neurological conditions,
• or illnesses with fluctuating or invisible symptoms.

In these cases, longitudinal medical records, functional restrictions, and consistent reporting become essential.

Tactic #5: Surveillance and credibility attacks

Surveillance is frequently introduced or intensified around the 24-month mark.

Short video clips or isolated observations may be used to argue that a claimant’s reported limitations are exaggerated. These observations rarely capture pain levels, recovery time, symptom flares, or the cumulative impact of activity—but insurers often rely on them heavily.

Preparing for the change of definition before it happens

The strongest LTD claims are prepared before the definition changes.

If you are approaching the 24-month mark, preparation should include:

• reviewing your specific policy wording,
• ensuring medical records clearly outline restrictions and limitations,
• documenting cognitive, psychological, and fatigue-related symptoms,
• addressing stamina, pace, and predictability,
• being cautious about premature or poorly structured return-to-work attempts.

Waiting until benefits are terminated often makes everything harder.

The importance of applying for CPP Disability early

Most LTD policies require claimants to apply for Canada Pension Plan Disability (CPPD) benefits. Insurers often insist on this, and CPPD plays a significant role in long-term LTD claims.

CPPD approval is evidence of a severe and prolonged disability, even though insurers may still deny LTD benefits after the definition change.

Timing matters

CPPD decisions take time, and initial denials are common.

As a general rule:

• CPPD applications should be made at least six months before the change-of-definition date.
• Where disability is expected to continue long-term, applying as early as one year before the change is often prudent.

Applying early helps avoid income gaps and ensures that the CPPD process is already underway if LTD benefits are terminated.

For more on insurer-requested CPPD forms, see our discussion in the LTD blog section:
Long-Term Disability Blog

What if your LTD benefits are terminated?

If your LTD benefits are terminated at or around the change of definition, you may still have options.

Depending on your circumstances, those options may include:

• appealing the insurer’s decision,
• submitting additional evidence,
• or starting a legal claim.

We discuss these considerations in more detail in My LTD Has Been Denied — Should I Appeal?.

If you have questions or concerns about your LTD benefits, we can help you guide you and protect what you fought hard to obtain.

Mulqueen Disability Law is a boutique law firm, focused on litigating long-term disability insurance benefit claims. Courtney Mulqueen and her team of legal professionals are Trauma-Informed Certified and have over two decades of experience exclusively in the area of long-term disability law. She and her team draw on their “insider” experience working for the insurance companies (including, Canada Life, Sun Life, Manulife, and OTIP), that they now sue for their clients.  

The preceding is not intended to be legal advice. This blog is made available for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog, you understand that there is no solicitor client relationship between you and the blog publisher. The blog should not be used as a substitute for competent legal advice from a licensed lawyer in your jurisdiction. If your disability claim has been denied and you require legal advice, please contact a lawyer specializing in disability law.