Any Occupation LTD Policies Video
Mason Waring: Hello. My name is Mason Waring. I’m an attorney and partner at Chisholm Chisholm & Kilpatrick. I’m joined here today by my colleague, attorney Leah Small. We devote much of our practice to handling long-term disability insurance claims, court litigation, and appeals. We help disabled workers who received long-term disability insurance from their employer or purchased policies directly from the insurance company.
Today, we’re going to be talking about any occupation insurance claims. We’re going to discuss what it means to meet the definition of any occupation disability and variations of any occupation definition based on earnings or occupation qualifications.
If you file for long-term disability insurance, you must meet your policy’s definition of disability in order to receive benefits. Typically, there are 2 kinds of definitions of disability that a claimant will be required to meet. One is own occupation disability, and the other is any occupation disability. Which one you will need to meet depends on your specific policy. Often, you might have to transition from one definition to the other. Often, for the first 12, 24, 48 months, it’s own occupation definition of disability, and thereafter, it transitions to any occupation.
Leah Small: Generally speaking, after that first period, as you mentioned, 12, 24, or 48 months, it’s no longer enough if you just can’t do the job you were doing at the time you became disabled. At that point, in order to continue to receive benefits, you have to demonstrate that you’re unable to do the material duties of any occupation. And as we’ll talk about a little later on of what exactly that means, it can vary from policy to policy. But it’s important when you’re filing that claim if your policy does have that transition to any occupation when you initiate your claim, think about not only how your medical condition keeps you from doing your own job, but start thinking early on, how does it keep me from doing any occupation? So, you can build that foundation at the initial start of your claim. And so, when you face that transition, later on, it’s hopefully a little easier for you.
It’s important to note that although this is how many policies operate, not every policy is structured this way. Some policies only require claimants to meet that own occupation definition the whole time. Others might require you to meet the any occupation definition from the outset of your claim. So, it’s really important to read your policy to make sure you understand exactly what definition you need to meet and when.
Mason: And so, there are different kinds of any occupation definitions of disability in the policies. Leah, can you go into more detail about some different variations?
Leah: Some policies have just very broad, vague any occupation definitions. It might just say the claimant must be unable to perform the duties of any occupation, and that’s it. This type of policy can be problematic because it’s often challenging to satisfy such a broad definition. For example, the insurance company might say that if you can do any job, even a part-time job that’s not within your prior field, you’re no longer entitled to benefits. And in circumstances where your policy has that kind of condition, it can be really useful to bring a lawyer in if you’re worried that the insurance company’s going to terminate you when it switches to this definition, or if they do terminate you because we can help you gather the specific evidence you’ll need including medical evidence and vocational evidence to prove that you can’t work in any occupation. And if necessary, we can also help fight the insurance company in how they are interpreting that broad definition because potentially, it may not be supported by the policy language that’s really as broad as the insurance company is saying. A lawyer can help you make those arguments.
Mason: As a general matter, the any occupation definition of disability can be harder to meet than the own occupation. Is that right Leah?
Leah: Correct. Generally, yes. Depending on what your occupation was, but yes.
Mason: Right. Because own occupation, it’s whether you can do the material duties of the occupation you were doing before. That’s generally, typically, how it is. And we have a video talking more about own occupation definitions of disability. With any occ, often, it’s whether you can do any job and Leah’s going to talk about some qualifiers there, but it really speaks more to an inability, a broader inability, to work. And often, you need to be more disabled to meet that any occupation definition of disability. So, let’s talk more about that. Some policies contain that narrower any occupation definition of disability. Leah, what do those look like?
Leah: Some policies will specify that you must be disabled from any gainful occupation. And typically, under any gainful occupation definitions of disability, the insurance company will look at whether you’re able to perform an occupation that earns you a certain percentage of what you were earning prior to your disability. Usually, it’s 60 to 80% of your pre-disability earnings. For example, an any gainful definition of disability might say you must be disabled from a job that earned you at least 60% of your pre-disability earnings. And if you earned $100,000 per year prior to your disability, you only need to demonstrate that you are unable to do a job that would earn you at least $60,000 per year. If you can do a job that earns you less than that, you may still be entitled to benefits under a gainful any occupation definition of disability. And this becomes significant, especially for people who were high earners prior to their disability because the gainful threshold is, therefore, higher and those occupations are generally more demanding. And so because of this, the insurance company may have a harder time finding jobs that you can perform given your medical condition.
Now, other policies might not have a gainful component, but they may say you must be disabled from occupations that you’re qualified for based on your training, education, experience, or sometimes, even, age. This can also significantly impact your claim because, for example, you may only have a high school education and perform manual labor for your entire career. You may still be entitled to benefits even if you could go perform office work physically given your medical condition because you’re not qualified to go work in an office, given your training, education, and experience.
Mason: Thanks, Leah. And it’s important to note that even if you have a definition that takes your earnings or other qualifications into account, it may still be difficult to prove your claim. Insurance companies often use vocational experts or outside vendors to look at the work and claim history and determine whether you’re able to work in other certain jobs. And so, it’s important to put together a strong case for your disability to prove your entitlement to benefits.
One thing that we do see insurance companies do is take a real narrow view of your health situation. And so, if you’re suffering from like 3 different conditions, which have impairing effects, just something basic. Let’s say you have a sleep disorder and you have chronic pain. I guess we’ll go with 2, the most simple. They may look at them individually. One or the other may not be enough to disable you from working in any occupation, but together, they make collectively render you disabled. And so, one tactic that is used is they will look at everything in a silo instead of looking at you as a whole person. And it’s really important to do that. And so, both medically and vocationally, you really want to make sure that you’re being taken into account as a whole person.
That’s something that we spend a lot of time doing for clients. Whether it’s an initial claim, people come to us for help on the initial claim, or for an administrative appeal, if they’ve already received a denial. We take the time to get to know you, what your work life was like, how your health is impacting your personal life, what the realistic prospects are for improvement in your health, and really tell your story. It’s a hard thing to do and particularly, if you’ve been in the trenches working and pushing through an illness and you’re busy taking care of your health and you have financial stresses, it’s hard to have a clear vision about your picture. And that’s something important that we bring to the table here, in addition to all the legal expertise that we have. If you need help with a claim and appeal, don’t hesitate to reach out for a free consultation, we’d be glad to talk to you. Leah, can you sum things up for our viewers?
Leah: Step 1, read your long-term disability policy so that you’re aware of how your particular insurance company and policy defines disability under that any occupation definition. It’s really important that you understand that so that you can determine what kind of evidence you need to submit to support your continued disability when you transition to that definition. As we discussed, insurance companies might have very broad any occupation definitions of disability, but they might also have a narrower definition that takes into account your qualifications or what you were earning prior to disability. If you’re facing that transition to the any occupation definition of disability, it can be really useful to hire an attorney, like CCK, at that point because this can be a difficult and confusing time to navigate. And as you mentioned, we have experienced helping individuals navigate that process whether it’s getting vocational evidence from an expert who can analyze what training, education, experience a claimant has, what they were doing prior to their disability, and how that compares to their medical condition and really put together a holistic evaluation of whether they meet that any occupation definition of disability given all of that.
Like I said, it costs nothing to reach out and contact us if you’re facing this transition, you’re having difficulty demonstrating that you’re entitled to continued benefits under the any occupation definition. You can give us a call and we’re happy to talk with you and see if we’re able to assist.
Mason: Yes, our phone number is 401-331-6300 and our web address is www.cck-law.com. Thank you all for tuning in here today. And Leah, thank you for that great information. Have a great day, everybody.
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