What to Know If Your Definition of Disability
July 27, 2022
Long-term disability (LTD) policies can contain a variety of definitions, clauses, exclusions, and other “fine print” that can come back to haunt the policyholder when a disability prevents them from working. Two very frequent definitions contained in an LTD policy are “own occupation” and “any occupation.”
Some disability policies may only cover you if you are unable to work at “any occupation” for which your training, skills, and background prepare you. A more generous but probably rare policy will cover you for your inability to work your “own occupation” at the time of disability.
Most frequently, however, an LTD policy will contain both definitions as contingencies. When you first go out on disability from your own occupation, you only have to prove that you are unable to perform the essential duties of your present position. Then, after a period – often 24 months – the prevailing definition switches to any occupation.
At this point in time, you will receive a letter announcing a “change of definition,” which means that your own occupation period has ended and any occupation period has commenced. You’re facing the elimination of your benefits and being forced back into the workforce at any job for which you are suited. What can you do?
If you’ve reached the point where you’re facing a change or definition of disability in your long-term benefits in or around Minneapolis, Minnesota, contact the long-term disability attorneys at Beedem Law immediately. We have more than 50 years of combined experience, and we can help you deal with the insurance company and its efforts to deny your benefits.
Beedem Law also proudly serves clients in Minneapolis, St. Paul, and Duluth, as well as the counties of Hennepin, Ramsey, Dakota, and Anoka, Minnesota.
What Does Change of Definition Affect?
Obviously, if you receive a change of definition letter, the insurance company is looking to the bottom line and hoping to eliminate your benefits. It can be a jolting experience, to say the least, but the first thing to remember is that any occupation is not an open definition.
If you were a software engineer, the insurance company cannot order you to grill hamburgers as your job. They must show that you can find a job in a field for which your education, skills, and experience qualify you.
A typical clause in an LTD policy describing any occupation might be worded as “any occupation for which the insured would be reasonably suited by means of his or her education, training and experience.”
There is also often an equity clause stating that the new “any” position should represent at least 60 percent of the wages the insured earned before going on LTD benefits.
The announcement by the insurer of the change of definition will often be followed by an investigation, which might entail a questionnaire the insurer asks you to complete or even an interview to assess your skills and options for work. The insurer may conduct a “Transferable Skills Analysis” (TSA) to determine alternative occupations for which you may be suited. The insurer may also order an independent medical examination (IME) by an independent doctor to determine your level of disability.
What You Can Do
First, you need to confer with your own medical team and determine the exact scope of your disabilities. Your medical team may be able to point out to the insurer that your physical and/or mental conditions make it nearly impossible for you to suddenly pursue a related but perhaps totally new position.
If your disability is total, then any occupation clause is rendered pointless. You deserve to continue with your LTD benefits.
Also, you need to be in close contact with an experienced LTD benefits attorney, such as those at Beedem Law, to advise you every step of the way and even deal directly with the insurance representatives. Your attorney should also closely examine the wording used in your policy, especially when it comes to defining disability and also in defining your own occupation and any occupation. The definition of disability may be broad enough that your condition enables you to avoid any occupation scenario.
If Your Benefits Are Denied
You can always appeal the insurance company’s decision. If your policy was purchased at work, it will be covered by the Employee Retirement Income Security Act (ERISA), which sounds employee friendly but contains provisions protecting the insurance companies as well. ERISA sets forth standards for appealing.
If you purchased your policy directly from an insurer, then the insurer will specify the appeals procedure in the policy. Of course, you can always take the appeal to the court if all else fails. For any appeal, you need to be working with an experienced LTD disability attorney.
Turn to Reliable Representation
As soon as you’re notified of a change of definition and you’re being thrust into the category of any occupation, contact us at Beedem Law. Our LTD disability attorneys can advise you on steps to take moving forward and help you launch an appeal if your benefits are terminated. We have the experience, knowledge, and resources to help you fight for the preservation of your benefits.
Beedem Law proudly serves clients in and around Minneapolis, St. Paul, and Duluth, as well as throughout the counties of Hennepin, Ramsey, Dakota, and Anoka, Minnesota.