Disability Denial Reason #2 - Change of Disability Definition & Vocational Review
One of the top reasons for terminating a claimant’s long term disability benefits involves the change in the disability insurance policy’s definition of “disability.” This definition change often happens in conjunction with a vocational review, or an analysis of a claimant’s medical records that tells the insurance company which jobs the claimant should be able to perform. It’s crucial for long term disability insurance claimants to know what to expect from the vocational review process and what one’s medical records must show in order to continue to qualify for long term disability benefits.
Usually 6 months prior to the change in your definition of “disability” the insurance company will start reviewing the claim to determine your continued eligibility.
If you have a group or ERISA long term disability policy, you can usually expect your policy’s definition of disability to shift at around the 24-month mark. This means that after you’ve been on claim for a year and a half, the disability insurance company will begin digging into your medical records and claimant statements to see whether you’ll still qualify for benefits under the policy’s new definition of disability.
This new definition is the “any occupation” standard – that is, your benefits will continue only if your medical records and the vocational review show that you’re unable to perform any occupation, not just the last job you had before you went on claim.
What does a disability company vocational review involve?
The disability insurance company has a vested interest in denying benefits whenever it has a reasonable basis to do so – and since the insurance company undertakes this vocational review on its own, this can mean that it’s a fairly cursory process. It’s also common for the vocational reviewer to look at the types or levels of activities you can do on your best day and extrapolate this into a 40-hour-a-week job. It’s important for a claimant’s medical records to emphasize that even if the claimant can do certain tasks in moderation (like sitting, standing, walking, lifting, or bending), this alone isn’t enough for them to hold down gainful full-time employment.
Can the disability company just find any job and rely on that as a basis to deny long term disability benefits under the “any occupation” definition of disability?
Even under the “any occupation” definition of disability, you’re not necessarily expected to work a minimum wage position. The disability insurance company will take into account your education, skills, and prior positions, and it generally won’t consider a job to fall within the “any occupation” standard unless it pays 60 percent or more of your pre-disability pay.
Can disability insurance companies rely on a Social Security Disability benefit denial as a basis to deny your long term disability insurance claim?
Long term disability insurance and Social Security Disability (SSDI) are two very different programs with different requirements and standards. Many claimants must apply for SSDI multiple times before they’re approved, and this process can take a long time. Because of this, an SSDI denial isn’t a valid basis to deny your long term disability claim if your medical records and other documentation show that you’re unable to work full-time.
Hiring a vocational consultant to prepare a report for your appeal and also undergoing a functional capacity exam may be very helpful in winning your appeal.
One way to fight back against the vocational review process is by hiring your own vocational consultant who can rebut the disability insurance company’s vocational report. Undergoing a functional capacity examination, which performs a deeper dive into how your symptoms and limitations can prevent you from working, can also be a good way to fight back against any attempts to end your long term disability benefits.
Don’t go through this process alone – let Dell Disability Lawyers help. We’ve worked with thousands of people to secure their continued long term disability benefits, even after the vocational review process. Just give us a call today to schedule your FREE consultation with one of our long term disability insurance attorneys.
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