One of the most important periods in many LTD claims occurs approximately two years after disability benefits begin.
Many LTD disability policies contain two different definitions of disability.
During the initial period—often the first 24 months—a claimant may qualify for benefits if their medical condition prevents them from performing the essential duties of their “own occupation.”
After this period, the definition commonly changes. To continue receiving benefits, the claimant may have to establish that they are unable to perform the duties of “any occupation” for which they are reasonably suited by education, training or experience.
This is commonly referred to as the change of definition or change of occupation period.
Insurance companies frequently conduct a significant review of LTD claims as this date approaches.
Does “Any Occupation” Mean I Have to Be Incapable of Doing Any Job?
Not necessarily.
The words “any occupation” can sound as though a person must be completely incapable of performing any conceivable employment before they can continue receiving LTD benefits.
That is generally not how the analysis works.
The specific wording of the insurance policy is extremely important. Depending on the policy, factors such as your education, training, work experience, medical restrictions and limitations, and the nature of potential alternative employment may all be relevant.
For example, the fact that someone may theoretically be capable of performing a few hours of employment activity does not automatically establish that they are capable of maintaining suitable, competitive employment on a reliable and sustainable basis.
Disability is about more than whether you can perform an isolated task. The real question may include whether you can perform the requirements of suitable employment consistently, predictably and over time.
If your insurance company has recently scheduled a medical examination for you to assess whether you meet the change of definition, or if your long term disability benefits are denied, it is often wiser to immediately contact a long term disability lawyer rather than attempting the ‘appeal process’ offered by insurers.
Call me today so we can discuss your circumstances. I never charge for a consultation and am always happy to speak to you about your case.
