Understanding the Definition of ‘Total Disability’ in Insurance Policies

If you’re applying for disability benefits, understanding how “total disability” is defined in your insurance policy is critical. In Ontario, insurance companies often use specific criteria to determine whether someone qualifies, and these definitions can vary significantly between policies.

Total disability typically means that an individual is unable to perform the essential duties of their own occupation due to illness or injury. Some policies start with an “own occupation” definition and later transition to an “any occupation” definition after a certain period (commonly two years). This means the insured must be unable to work in any occupation they are reasonably suited for by education, training, or experience.

This shift in definition can lead to disputes between the insurer and claimant. The insurer may argue that the individual can perform some other type of work, even if it’s less suitable or pays significantly less.

Medical documentation is key. Your doctor’s opinion, along with detailed reports about your diagnosis, treatment history, functional limitations, and prognosis, all help determine whether you meet the definition of total disability.

If your benefits are denied based on this definition, you have the right to appeal or pursue legal action. For support interpreting your disability insurance policy and advocating for your rights, contact Hilborn and Konduros in Cambridge, Ontario.