Long-Term Disability Claims: Understanding the Process, Changing Legal Definitions, and How I Help Employees and Employers

Learn how the legal definition of disability changes after two years in LTD claims and how I help both employees and employers navigate the process for fair, compliant outcomes.

Long-term disability (LTD) benefits are a vital safety net when an illness or injury prevents someone from working for an extended period. Applying for LTD can be complex and stressful, and many people don’t realize that the legal definition of disability changes after the first two years—a factor that can dramatically impact eligibility.

As an HR professional with a background in employment and labour law, I work with both employees and employers to navigate every stage of this process. My role is to ensure that all parties understand their rights, obligations, and the documentation needed to support or evaluate a claim fairly.

Step 1: Initiating the LTD Claim

The LTD process typically begins with three required forms:

1. Employee’s Statement – Completed by the employee, outlining their condition, symptoms, and impact on work.

2. Employer’s Statement – Completed by the employer, confirming the employee’s role, duties, salary, and work history.

3. Physician’s Statement – Completed by the treating doctor, providing medical evidence of the disability and work restrictions.

   
   

I help employees ensure their forms clearly and accurately reflect their situation, while I assist employers in preparing complete and legally compliant employer statements that reflect the realities of the workplace and job duties.

Step 2: The Initial Legal Definition – “Own Occupation”

For the first 24 months of LTD benefits, most policies use the “own occupation” definition of disability:

• The person must be unable to perform the essential duties of their own job because of illness or injury.

• It does not require that they be unable to work at all—only that they cannot perform their specific role as normally carried out.

For employees, I work to ensure the job duties and medical limitations are clearly documented. For employers, I help provide accurate job descriptions, essential duties lists, and any accommodation history to support a fair evaluation by the insurer.

Step 3: The Definition Changes – “Any Occupation”

After 24 months, the definition often changes to “any occupation”:

• The person must now be unable to perform the duties of any occupation for which they are reasonably suited by education, training, or experience.

• This is a higher threshold—if the insurer determines the employee can work in another capacity, even at a lower skill or pay level, benefits may end.

At this stage, I help employees anticipate and prepare for the change in definition, and I assist employers in understanding the insurer’s reassessment process, ensuring all communication is accurate and compliant.

Step 4: Appeals and Ongoing Evidence

If benefits are denied, appeals can be made by providing:

• Additional medical evidence

• Specialist assessments

• Clarification of job demands and functional limitations

• Documentation of failed return-to-work attempts

I support employees in organizing strong appeal packages, and I guide employers in responding to information requests in a way that is truthful, legally compliant, and respectful of all parties.

How I Help Both Employees and Employers

As a neutral, experienced HR professional and former employment lawyer, I:

• For Employees: Explain LTD policies in plain language, coordinate medical and job-related documentation, and provide guidance through both initial claims and appeals.

• For Employers: Ensure employer statements are accurate and defensible, assist in managing workplace accommodations, and reduce the risk of disputes or non-compliance.

• For Both: Facilitate open, confidential communication to prevent misunderstandings, manage timelines, and ensure compliance with legal requirements at each stage of the LTD process.

By understanding both sides of the table, I bridge the gap between employees, employers, and insurers—helping to create fair, respectful, and legally sound outcomes during what can be one of the most challenging times in a working relationship.