Many group and individual disability insurance policies provide protection in the event that a claimant cannot perform the material duties of their Own Occupation (“Own Occupation Period”) for a limited period of time (typically 24 months). In many policies, after the Own Occupation Period expires the definition of Total Disability changes to the inability to perform the duties of any gainful occupation (“Any Occupation Period”). Occasionally, this definition will include an Earnings Qualifier, which means that if the claimant can work in another occupation, but cannot perform the duties of an occupation that would allow him or her to earn a certain percentage of their pre-disability income, they would still be considered Totally Disabled.
One of the most frequent points in a disability insurance claim in which benefits are terminated is during the transition from the Own Occupation Period to the Any Occupation Period. The definition of Any Occupation is much more stringent and claimants are not always aware of the impact of the change in wording. Very often, insurance companies do not explain to claimants what type of information is necessary to establish a Total Disability at the Any Occupation Period and they are caught off guard when a denial occurs based on a lack of sufficient proof. Frequently, well before the change in definition period, we will have our clients undergo an independent medical examination, have them evaluated by a vocational rehabilitation expert, and interview and obtain statements from their physicians to address the claimants’ ability to work in any gainful occupation. Moreover, many claimants are lulled into a false sense of security because they were determined to be disabled by the Social Security Administration (“SSA”). They are shocked when they receive a denial stating that the SSA’s standards are different than the carrier’s standards. We typically will send in the complete file from the SSA, which often includes independent medical and vocational assessments.
It is imperative that you properly and timely prepare for a change in Total Disability Definition transition. Knowing your rights and obligations may prevent a suspension or termination of your benefits. If you have any questions or would like to discuss your disability claim or a potential disability claim, please contact us for a free consultation at www.dilawgroup.com or call us toll free at (866) 363-3628.