Question regarding commensurate occupation

1st time post (I believe? Lol)…long time reader, this site is fantastic.
I had a question regarding the term commensurate occupation, I’m currently looking at being cut off next month. I’m suffering from neurological pain in areas that ain’t nice to talk about to put it nicely. I’m also facing central sensitization, and become hypersensitive.
I’m hoping that an upcoming treatment will have some effect, so far I’ve been to over 100 physiotherapy sessions. I spoke with my doctor and she advised the insurer that I couldn’t work more then potentially 20hrs a week in a letter. I face severe pain when sitting or doing repetitive tasks, the pain builds. Theres a long list of what I face, I’ve even lost consciousness once and almost a few other times from pain.
So…back to the question, how is the insurer able to ignore the maximum number of hours I can work being maybe 20, and say I’m able to work a commensurate occupation? (My previous work week was 37.5hrs)
Any light that can be shed is appreciated!


Has the insurance company said this?
I would get free consult:
Free Consultation Request — Resolute Legal

I found this thread interesting:

Specifically this comment:

Do have your benefit booklet to check the wording?

Because they can.
You may have to sue to get your LTD back.

Best of luck.

I did a search on this forum for “any occupation”.

Do they have a doctor report saying you can return to work? They tried this with me even though they had doctor reports saying I couldn’t not work until my issue was resolved. All I did was appeal and ask them to provide me with something from a doctor that states I can return to work. They couldn’t provide it and my benefits continued.

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Your doctor stated you could work. It doesn’t matter what the hours were, you can work therefore the insurer can discontinue your benefits.

If your doctor changes her official medical opinion and says you cannot work at your, or any other job then you should get reinstated.

I disagree, depending on the wording of the policy, the limit of working might be 'gainfully employed".

I would contact a lawyer if you’re cut off.

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I did a consult with a lawyer, at 20hrs a week I’m considered totally disabled under my plan. It falls short of the commensurate occupation salary. Was advised it appears I have a case.

Thanks for the replies, I’m going to keep my replies to a min in the event of litigation.

Yes there was a report allowing me to attempt light/ sedentary work. Employer refused to accommodate (specialized position, and safety concerns), the 20 hrs was me being ambitious and my Dr supporting my desire to attempt to work again.

It always comes down to the wording of the policy!

Good Luck!
Keep us posted when you have an outcome.

They must accommodate you for a gradual return to work. You can return on ltd within a timeframe if you are having a difficult and cannot work. My policy states ibhave to be back for 6 months fulltime before they will close mt file.

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The wording of the plan is important. My plan had no clause of return to work timings/back on disability plan. In my case, there was an attempt between my disability insurer and former employer to fire me on my first day back on my rtw plan (for having an overpayment with he disability insurer) and I would no longer be eligible for disability benefits as an ‘employee’.
I would have absolutely followed through legally had it happened, but in the end, the disability insurance company decided to accept my LTD (almost a year later than the contract stated) and continue my payments.

Very strange. I wouldnhave pursued them. Insurance companies for ltd are awful. They add more stress to people who are sick, its terrible. I dont understand why they would collude to have you fired? Why would there be an overpayment? Seems fishy to me.

It absolutely was fishy and almost 4 years later I have a clearer view of what went on, but not before I thought I had lost my mind.

From the insurer’s files and court documents in my wrongful dismissal it looks like neither the insurer nor my former employer wanted to pay out for LTD for up to 17 years. There was a contract dispute between them over who was going to pay my claim after my former employer was cost cutting and abruptly changed disability insurers after 20 years.

Looooong story short, my former employer (well, the temporary manager actually) was just looking for a reason to fire me. In the past I had complained to several board members about 2 sexual harassment incidences with this male. I had also encouraged my replacement to report about the same type of behaviour from him.
When the case manager (looking for a way out of payment) told him I had an overpayment from short term disability (I had returned to work to hire and train my replacements and the STD payment and a pay cheque overlapped 3 weeks), he used it as a breach of trust termination. When the dust settled, the overpayment was not as big of a deal as it was made out to be, my LTD was approved AND I had filed a wrongful dismissal against my former employer.

It was far worse than that little blurb let me tell you! The insurer not only added more stress, it has been documented in my files that they are why I am far worse than when I started. They suck.