A year or two after you’ve begun receiving long term disability benefits, your policy’s definition of “disability” may change—and not for the better. After your definition of disability changes, you may find that it’s tougher to qualify for disability benefits. Below, learn more about how most long term disability insurance policies define “disability” and how you can prepare for this change.
It is important to understand the definition of disability in your policy and plan for the change at 12 or 24 months.
The change of disability definition is most common in group policies, often referred to as “ERISA” policies (after the Employee Retirement Income Security Act provision that encourages employers to provide these disability benefits). When you first begin receiving benefits, your policy likely defines “disabled” as “unable to perform the substantial material duties of your own occupation.” This “own occupation” standard doesn’t define your job duties based on your specific employer, but on how the Department of Occupational Titles defines your occupation—and this definition may be very different from your actual job duties.
After you’ve been receiving disability benefits for two years, this definition becomes even narrower. At the 24-month mark, you’ll be able to receive long term disability benefits only if you’re unable to perform the substantial material duties of any occupation you’re trained and qualified for. Again, the disability insurance company will use the Department of Occupational Titles to define “any occupation,” and it may presume that you can do just about any sedentary job, no matter how mentally or emotionally taxing.
At least 6 months before the change of disability definition you need to take steps to be prepared for the new disability definition.
Failing to prepare for the change of disability definition can be a quick path to claim denial. If you’re not prepared to prove your claim under the “any occupation” standard, you could find yourself scrambling at the 24-month mark. Instead, start preparing about six months before the definition of disability changes so that you’re armed with the medical and vocational records you need to continue your disability benefits.
We regularly work with vocational experts to prepare reports about the potential jobs a person could perform based upon restrictions from doctors, prior job experience, and job availability.
One common misconception about the “any occupation” standard is that it doesn’t account for education, skills, or pay. However, even under ERISA disability insurance policies (which tend to have fewer provisions than private insurance policies), a claimant will be considered able to perform a certain occupation only if it is a match for their skills, training, and education, and if the job pays a certain percentage (usually around two-thirds) of the claimant’s pre-disability pay.
At Dell Disability Lawyers, we frequently work with vocational experts who can review your skills and abilities and create a report detailing exactly what jobs are open to you and what the employment prospects are for each. This can go a long way toward proving your disability (or disproving the insurance company’s argument that if you can sit for a few minutes, you can perform any sedentary job for 40 hours or more a week.
You must complete the vocation claim forms provided by your disability company with caution and documented support for each answer.
After you’ve been on claim for 12 to 18 months, you’ll begin receiving vocation claim forms from your disability insurance company. These claim forms must be completed truthfully, but with an eye toward what the insurance company sees. For example, if your doctor has spent more than a year explaining that you can’t stand but are able to sit for long periods, it will look suspicious if he or she claims that you can’t sit or stand right around the time your definition of disability changes.
When asked to give an interview with the disability company assume they have been watching you and researched all of your activities the prior several months and weeks after the interview.
After a claimant has hit the 18-month mark, if not sooner, they can assume that the disability insurance company has been keeping close tabs on them. This can mean video and social media surveillance, among other covert research. The insurance company will then use the information they’ve gleaned to ask you questions about your activities. If you aren’t truthful about what you’ve done (or haven’t done), you can expect the insurance company to quickly pick up on this falsehood; and because so many disability claims hinge on the claimant’s credibility, losing credibility when your definition of disability changes can mean a permanent end to your benefits.
Your treating doctors should be aware that the disability company will call them to discuss your restrictions and limitations.
Although the initial claim approval (or denial) is often made on a paper record without ever talking to the claimant’s treating physician, the change of disability definition process is much different. The disability insurance company may contact your treating physicians at any time to double-check your symptoms and limitations, and if they’re not satisfied with your answer, your benefits may end.
If you’re not sure you’re prepared for the change of disability definition—or just want a bit of extra help—look no further than Dell Disability Lawyers. Our experienced attorneys have helped thousands of claimants over the change of disability hump, and we can help you too. Just give us a call today to speak with a member of our legal team.