If your insurance company terminates your disability benefits after 24 months because your medical condition no longer meets the definition of total disability provided for in your contract, what is your burden of proof?
At this point, your burden is limited to establishing in a sufficiently convincing manner, with medical evidence to support it, that your state of health is such that you are unable to perform a job corresponding to your abilities and for which the remuneration is equivalent to that of your former job.
Then, it will be up to the insurer to demonstrate that other jobs for which you have the required education, training and experience exist and that you are able to perform them despite your medical condition. It is important to keep in mind that there must be a certain connection between the job suggested and your former job and that it must be comparable in terms of professional interest and remuneration. Essentially, this means that the new job must provide an income that is sufficient enough to maintain your standards of living. For example, in a recent decision, the Tribunal determined that a job providing a gross income equivalent to 60% of the applicant’s gross income at the time of disability did not correspond to comparable remuneration. It is also established that it is the gross income from the previous job that must be taken into account and not the amount of disability insurance benefits paid!
In the same decision, the worker suffered from lumbar osteoarthritis with severe symptomatic disc disease and was employed as a mechanic at the time of his disability. The Tribunal determined that he was unable to hold the jobs suggested by his insurance company because they did not correspond to his professional background, did not respect his functional limitations or did not provide him with comparable remuneration.
If in doubt, consult us!