A Long-Term Disability Lawyer Explains the Concept of Change of Definition in a Long-Term Disability Policy
When you’re approved for long-term disability (LTD) benefits, it can feel like a huge relief. Unfortunately, many people are caught off guard if the insurance company denies their LTD benefits at a later time. Often claims are denied because many LTD policies include a “change of definition” clause, which shifts the eligibility criteria from “own occupation” to “any occupation”. Consulting a long-term disability lawyer can provide you with insight about the change of definition.
What Does “Own Occupation” Mean?
In the initial stage of LTD benefits (usually the first 12-24 months), eligibility is often based on whether you can perform the essential duties of your own occupation. This means that if your illness or injury prevents you from doing your specific job, even if you could work in a different role, you qualify for benefits.
For example, if you’re an office worker with a serious back injury, you may qualify for LTD benefits because you cannot materially perform the essential duties of your own occupation.
The Shift to “Any Occupation”
After a period of time (as defined in your policy), most LTD plans change the definition of disability from an “own occupation” test to an “any occupation” test. This often means that the insurer will reassess your claim to determine if you are able to return to work in any job that you are reasonably suited for based on your education, training, reward, or status.
The “any occupation” test is a more stringent test to meet and may result in the LTD claim being denied. If an insurer is of the opinion that you can work in another occupation, they may decide to terminate your LTD benefits; this is when having an experienced disability lawyer is crucial.
How Insurers Use This Change
Insurance companies often use this transition point as an opportunity to:
- Conduct medical reviews
- Terminate LTD payments with little to no notice to the claimant
Advice from a Long-Term Disability Lawyer: Steps You Can Take to Protect Your Benefits
If you are approaching the change of definition test or have concerns about your LTD claim being paid on an ongoing basis, here are some proactive steps you can take:
- Review your policy: Carefully read your LTD policy to understand how “any occupation” is defined.
- Continue medical treatment: Regular medical documentation is crucial. Gaps in treatment can give insurers reasons to deny your LTD claim.
- Seek legal advice: Consulting an experienced long term disability lawyer can help you prepare for the insurer’s reassessment and any potential denial of LTD benefits.
How Can Aaron Waxman and Associates, P.C. Help?
Navigating the change of definition in an LTD policy is one of the most common challenges disability claimants face. Our firm provides extensive services in disability law, helping clients across Ontario understand their rights in obtaining LTD benefits and challenging denied LTD claims.
A disability lawyer in Toronto from our firm can:
- Review your LTD policy and explain your rights
- Communicate with your insurance company on your behalf
- Gather medical and vocational evidence to strengthen your case
Our goal is to ensure you are not left without financial support when you need it most.
Conclusion
The change of definition from “own occupation” to “any occupation” is a turning point in many LTD claims. If you have concerns regarding your LTD claim, seek out an experienced LTD lawyer.
Contact Aaron Waxman and Associates, P.C. today for a free consultation with a long-term disability lawyer.
We offer a free initial consultation that can be arranged at a date and time of your choosing and at your convenience.
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