Greetings all — I’m a federal employee on LTD (Industrial Alliance). After close to 2 yrs of LTD, my condition was more stable and I wanted to see if working a bit would help me build capacity. The Insurer agreed to provide an OT to help with a Gradual Return to Work (“GRW”). The OT said IA was going to cut me off at my change of definition date, but that day came and went long ago, and my GRW (and benefits) went on.
For the GRW I work from home, flexible/random hours, doing only the simplest part of my job, but after 20 months I still can’t do more than 10-12 hrs/week. So… what happens when my GRW fails/ends? Can IA then cut me off, saying I never met the change of definition? Or do my ongoing benefits mean they approved me? The contract definition is being unable to earn 2/3 of former salary, and clearly I can’t. But it worries me that IA never sent me a confirmation or decision. Should I ask them? or let sleeping dogs lie?
Through your your GRW program you’ve proven you are unable to meet the 2/3s work capacity your insurer would require to legally end your benefits. You’ve clearly met their change of definition requirement otherwise they would have cut you off.
I am familiar with your LTD policy having represented clients with it. It is a bit more nuanced that that inability to earn 2/3 of pre disability income. If you read it carefully, it qualifies that by saying:
“However, an employee who engages in any occupation or business, except as provided in the Rehabilitation provision of the Long Term Disability Benefit, will be deemed not to be totally disabled.”
So the key with this LTD plan is that they will keep paying as long as you are in the approved rehabilitation plan. If you read the section on rehabilitation, it says that these rehab plan run for 24 consecutive months. But can be extended longer at discretion of IA.
The policy I am looking at is a couple of years old so its possible it may have changed, but doubtful. Reach out to us for a free consultation if you get notice IA is going to stop your payments.
David Brannen
Disability Lawyer with Resolute Legal
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