Any Occupation and Commensurate Earnings


#1

Hi,

I’m new to this forum but I’m very glad I found it. There seems to be a lot of great information here. Thank you Resolute Legal for setting it up.

I am currently on LTD in Ontario in the own occupation phase.

From my employee benefits booklet any occupation is defined as “… for any occupation for which you are or may become reasonably qualified by education, training or experience.”

I am told by the insurer that from an earnings perspective that the change in definition is associated with something they refer to as “commensurate earnings”. The insurer defines this as 2/3rds of my pre-disability earnings. The insurer communicated this to me by email. No where in the booklet does it define this term commensurate earnings. Has anyone else heard the term commensurate earnings and/ or have seen it defined this way? Or is this just a rule of thumb that the insurer uses and maybe it is actually determined on a case by case basis.

I read in another thread on this forum about the “Master Contract”. Maybe this term and definition is defined in that document and I should be asking for it.

The reason I’m asking is my pre-disability income was fairly high and given my restrictions and limitations I think it will be difficult to find a position that pays me 2/3rds of my pre-disability income.

Any insight would be helpful. Thanks


#2

2/3 or 66% is very common in group policies. It should be in your group booklet but you can request a copy of the master contract so you are aware of all the provisions. You would make the request to your Insurer and Employer–by email or fax-proof of request.

Insurers love to speak in legalize or terms like commensurate earnings–it just means a wage less than you have now by a percentage. Your insurer says if you can make 66.7% of your wages that is suitable to your skills and such–then you will not meet the test for disability at the two year mark.


#3

I wouldn’t be overly concerned.
I understand why you are.
If you’re like me, you want to know everything.
Ive been on LTD for a year.
I’ve already been approved for the change in definition (after 2 years) but I know the insurance company can do whatever they want, whenever they want.
I could be cut off and have to sue anytime before age 65.
Depending on if the insurance company thinks it can win a lawsuit, you might be at a higher risk of being cut off because of your high income.
I’m sure the insurance company is very calculating when they decide to cut someone off.

Have you applied for CPP-D yet?
Do you think you would qualify?


#4

Thanks for your response.
No I haven’t applied to CPP-D yet and I haven’t been asked to.
I’m have no idea if I’d qualify.
Is this something I should be doing even if the insurer hasn’t asked?


#5

I applied before I was asked but my condition is degenerative so I knew I wouldn’t be able to work again.
I think you should apply but I am not an expert.
It takes 4 months or more to get a decision
The younger you are and the more money you make, the harder you might have to fight for it.
The better your medical documentation the easier it will be.

Read this:
https://resolutelegal.ca/cpp-disability-benefits/applying-cpp-disability-payments/

Do you know how to log in to the Service Canada website?
You can see an estimate there of how much you would get.
It all goes to the insurance company but it’ll help with any legal claim if you have to do that.


#6

What they are telling you is correct. It is not unusual for the commensurate earnings formula or amount to NOT be stated in the policy. This is something that often gets fought over. Courts have upheld the 2/3 formula even though not in contract or policy.

If you have a high income, then it does make it harder for them to show you have the capacity to earn 2/3 your income. That won’t prevent them from denying your claim, but it would be a strong argument for you if you ever have to sue them. We see this all the time.


David Brannen

Disability Lawyer with Resolute Legal

The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliable manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team.