If you are receiving LTD benefits and suddenly receive a letter from the insurance company that states you must meet the “any occupation” requirement, it may be confusing and seem unfair. After all, you’ve already met the qualifications for disability by proving you couldn’t work. And you still can’t work. So what is the insurance company talking about? Read below to learn more about the any occupation disability requirement and how to prove that you are still disabled.
Many LTD policies have a provision that defines total disability as being unable to perform the essential duties of:
Thus, if you are unable to work in your current occupation or a reasonable alternative, you may initially qualify for LTD benefits. However, after you have been receiving benefits for a period of 24 months, that requirement may change. You must be able to show that you are unable to perform the duties of any occupation. This type of modification is called a Change in Definition (CID) feature in a policy.
It is important to note that some LTD insurance companies may change to the any occupation definition of total disability after one year, 36 months, or 48 months. You should review your policy or check with your insurance company to determine the date that you will be required to prove you cannot work in any occupation.
If you were originally working in a strenuous job that required heavy lifting or frequent standing, it may have been relatively easy to prove that you were unable to do that type of work due to an illness or injury and you were disabled. However, once your benefits are based on an inability to work any occupation, you must be disqualified from being able to work in any type of job, including sedentary work, such as clerical jobs.
The insurance company understands that if you are unable to do any occupation, you will likely be receiving LTD benefits for a long period of time. Thus, they make it harder to continue qualifying going forward. The insurance company will often bring in a vocational expert (VE) to give an opinion about whether you can perform the substantial and material duties of any other occupation.
Some policies require that you should be able to perform work according to your age, education, training, and skills. Others require that the new occupation should result in your earning at least a certain percentage of your gross income prior to becoming disabled. However, many LTD policies have no restrictions on the type of occupation that you are qualified for after 24 months of receiving benefits. They will consider any type of work whatsoever. And if you are able to complete the duties, you may be disqualified for LTD benefits.
Leading up to the 24-month deadline, you will likely receive many documentation requests from your LTD insurance company. They will inform you that you have to once again prove that you have a disability. The insurance company has one purpose — determining what you are able to do so they can get you off the claim. Their goal is to dismiss your claim so they no longer have to pay you LTD benefits.
You will have to prove your disability, but in a more detailed manner. This will likely require you to collect additional evidence of your disability and your inability to perform tasks for work and activities of daily living.
It is important that you have maintained a good relationship with your disability doctor so they will provide you with ongoing medical evidence regarding your abilities and limitations. You should also continue keeping a diary or journal that records how your disability impacts your life. Your friends and family can also make a written statement regarding what they have seen about your limitations.
In many cases, the LTD insurance company is able to show that people are able to perform in at least one occupation when considering so many. In that situation, LTD benefits will be denied. You can appeal the decision with the help of a disability attorney who has experience fighting insurance companies and knows how to prove your claim.
If your LTD policy is now requiring you to prove that you cannot perform any occupation, don’t try to fight the insurance company alone. CJ Henry Law Firm PLLC can help.