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Posted on Tuesday, July 3rd, 2018 at 12:19 pm    

Most group long-term disability policies provide that, after the 24 months of LTD benefits are paid, the definition of disability (or total disability) changes from “own occupation” to “any occupation” (or other similar terms such as “any gainful occupation” or “any reasonable occupation).” This is, hands down, the point at which claimants are most likely to face a termination of their long term disability benefits.

It is critical to understand this transition in the definition of disability. At this point, the insurance company is no longer evaluating whether or not you can perform the particular occupation in which you last worked. The insurance company will now assess if you can perform any other occupations in the local, regional or national economy. The insurance company may now be able to consider if you are capable of performing any one of hundreds of potential jobs. You will typically receive a letter about six months prior to the date this transition in the definition of disability will happen. Consider this letter your warning shot.

If your prior occupation was in a job that required standing or walking for prolonged periods or lifting above 10 or 20 pounds, you are much more susceptible to having your benefits terminated. This is because the insurance company will likely take the position that although you cannot perform the material duties of your physically demanding former occupation, you can perform a sedentary occupation (or a desk job) on a full-time basis. The non-examining doctor hired by the insurance company reading your medical records will almost always provide an opinion that full-time desk work is permitted which may very likely lead to a termination of your LTD benefits.

Most policies also specify that the insurance company must fully evaluate if you possess the qualifications to perform less physically demanding desk jobs – specifically, your education, training and work experience. Also, there is often a wage requirement where the insurance company must evaluate if these other less demanding occupations can earn you 60% or 80% of your pre-disability income. There can also be requirements in the policy that you be able to perform these other jobs “with reasonable continuity.” Unfortunately, these critical issues are often ignored by the insurance company despite the clear language of the LTD policy.

Please know that if you receive an “any occupation” termination of your long-term disability claim, you must consult an experienced disability insurance lawyer like the ones at Capitan Law immediately. You are typically afforded 180 days to file an appeal. Rushing to file an appeal immediately is a very bad idea. Do not listen to the claim representative’s advice that in order to file an appeal “you only have to write a letter.” This is the worst advice you can be given. This appeal may be your one and only chance to submit relevant medical, vocational, and testimonial evidence. The insurance company will not tell you that you have the right to hire an attorney, but proceeding unrepresented and filing an appeal on your own can seriously harm your chances of getting your LTD benefits reinstated and may also damage the value of your claim. In short, you need an experienced disability insurance attorney now to help you fully develop your appeal – not after you have attempted to file an appeal on your own.

Please contact Capitan Law immediately if your long-term disability insurance benefits were wrongfully denied because the insurance company alleges you can perform “any occupation.” Our consultations are free, and we have a great deal of experience in helping disabled individuals navigate the “any occupation” claim review process, the appeals process, and in litigation if necessary.

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