You have been receiving long-term disability benefits for about 12-18 months and then you receive a letter from the insurance company that says something like this:
According to the provision of your group policy, in order to be eligible for LTD benefits you must meet the following definition of disability:
Total Disability or Totally Disabled means you are prevented from performing the Essential Duties of:
1) Your occupation or a reasonable alternative job offered to you by the employer during the elimination period and for the 24 months following the elimination period; and
2)After the 24 month period, Any Occupation.
Your LTD benefits became effective 12 months ago. To continue receiving benefits after 24 months, you must be disabled from any occupation.
Please be advised that we have initiated an investigation to determine if you will qualify for benefits after the 24 months have elapsed. We will notify you regarding our determination.
What exactly does this mean? You were granted disability benefits because you couldn’t work. You still cannot work. What is the insurance company talking about here?
Almost all (at least that I have seen) employer-provided long-term disability policies have a change in the definition of disability after you have been receiving disability benefits for 2-years (or 24-months). I have seen some that change after 1-year (or 12-months).
The change is that you must be disabled from performing any occupation instead of just your own occupation.
This is a major change.
For example, if your occupation was a truck driver at a light-medium exertional level, your back injury may qualify you for long-term disability benefits initially. When the definition changes, the question is does your disability prevent you from doing ANY OCCUPATION – such as clerical work, inventory work, or other sedentary type occupations.
The disability company understands that if you are entitled to benefits after this point in time, then chances are you will be receiving benefits for a long time. The disability company does not want this. The “any occupation review” is done by the long-term disability insurance company at or around the time the definition of disability changes in your policy. The change in definition gives the insurance company an opportunity to deny perfectly valid disability claims under the guise of the claimant being able to perform some type of occupation. In doing their “any occupation review,” the insurance company will often use a vocational expert (VE) to opine on whether or not with your disability you can perform the substantial and material duties of another occupation.
In some policies, the definition requires that you be suited for the occupation by age, education, training, or skill while others require that the occupation results in you earning, at least, a certain percentage of your pre-disability gross income. However, many policies place no restrictions on the type of occupation the insurance company can say you are qualified for.
You can expect to receive a number of documentation requests and/or interviews in the months leading up to your 24th disability payment. They all have one purpose — finding out what you can do so that they can get you off of claim, and/or bombarding you with so many requests that you may fail to turn one in and then your claim can be dismissed.
You will be faced with a completely new inquiry into your disability. Basically, you will have to prove your disability again, but probably to a more detailed level.
You will probably need to collect additional evidence of your disability and of your inability to perform the tasks the disability company now claims you can do.
If you are lucky, the definition of disability in your policy will give you some added protections – such as you must be able to earn a certain percentage of your pre-disability earnings.
It is important to maintain a good relationship with your doctor. Keep your journal/diary up to date. Make sure your family and friends know of your continued disability and can support your claims if needed.
The unfortunate truth of the "any occupation review" is that many claimants are found by the disability insurance company to be capable of performing, at least, one occupation. Because of this, continued long-term disability benefits will be denied.
If you are faced with an Any Occupation Investigation or Denial, you do not have to fight the insurance company alone. Mandeville long-term disability claimants faced with such a denial can call me for help.
Successfully appealing any occupation denials takes creativity, hard-work, and a detail-oriented approach. If you live in Kenner, or anywhere in Louisiana, and are faced with an Any Occupation long-term disability denial, I may be able to help you. Give me a call at 985-240-9773 or use our simple contact form.