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Disability Benefits Denied At The “Change of Definition”

Many Long-Term Disability (LTD) insurance policies will pay an insured benefits for an initial 24-month period if the applicant can establish that they are totally disabled from performing the essential duties of their ‘own occupation.’ This period is commonly referred to as the ‘own occupation’ period. The insurer considers your medical restrictions and limitations, as outlined by your medical treatment providers clinical notes and records, in light of your regular job duties. If the threshold is met; in other words, the insurance company determines that you are unable to perform your own occupation, given the objective medical evidence, then the insured will be approved for disability benefits.

Many disability insurance policies contain a change of definition at the 24-month period whereby the insurance company measures one’s entitlement to disability benefits on another yardstick. This period is commonly referred to as the ‘any occupation’ period, during which an insured will only qualify for benefits if they can establish that they are unable to perform the essential duties of any occupation commensurate with their education, skills, and abilities. This test is a higher threshold to surpass than the first 24-month period during which the applicant only has to show they cannot perform their own job. For individuals that have worked in various positions throughout their career, the insurer may look to any position somewhat related to your background and conclude that you are able to perform such a job, so you are not totally disabled from performing ‘any occupation,’ in an effort to terminate your disability benefits.

If your disability benefits have been terminated when the policy definition changed from ‘own occupation’ to ‘any occupation,’ contact our law firm today for a free consultation.

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