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Do Disability Insurance Companies Continue to Challenge a LTD Claim After an “Any Occupation Definition of Disability Investigation” Is Completed and Benefits Have Been Extended?

A visitor to our website recently posted this great question about the handling of long term disability insurance claims once the definition of disability changes from Own Occupation to Any Occupation.

The change of definition from Own Occupation to Any Occupation is probably the single highest cause for claim denials. An “any occupation” definition of disability is not always the same with every long term disability policy. Some Any Occupation definitions of disability state that the claimant must be unable to perform any gainful occupation and others state the claimant will be disabled from any occupation if he or she cannot perform a job that pays at least 60% of the pre-disability income. The change of definition period, which usually comes at the 18-24 month of an LTD claim is highly scrutinised by most disability companies.

The Level Of Scrutiny Varies With Every Disability Company

After the initial any occupation evaluation is completed the amount of scrutiny that can be expected differs among all of the disability companies. Some continue to manage claims with a high level of scrutiny while others will only request claim forms once every 6 months. The type of disabling condition also plays big factor in the amount of claim scrutiny to expect. “I would like to be able to say that a claimant can rest easy knowing their claim has been approved in the any occupation stage, but it is simply not true.”

We have been contacted by people that have been denied after being paid for 21 years, 15 years, 11 years, 6 years, etc. The claims person on a claim can change the level of scrutiny at anytime. Disability companies often have turnover with disability managers and a new manager brings about new methods for handling claims that have been approved from many years. A claimant can never let their guard down and they must always continue to obtain appropriate medical treatment and maintain outstanding medical documentation of their disabling condition(s).

In order to help claimants avoid claim denials and manage their claims on a monthly basis, we offer an affordable disability monthly claim handling service which you can learn more about by clicking here.

There are 4 opinions so far. Add your comment below.

Emesker:

I am not sure that I am doing the right thing… I contacted you before with a question and have come to the decision that no matter how hard I try, I cannot work! My problem is that against doctor’s orders, I went back to teaching at half-year in 2012… I missed so many days, it’s not funny. This year, the same thing (too may missed days and as a teacher your work only 187 days). I am just existing because all I can do is lie down take meds when I get home… I roll around the room on my desk chair because it is just too painful to stand all day and teach.

My question is this… after being threatened with questioning questions every couple of months and all these clauses that i had no idea existed were mentioned to me, I could not take it anymore so decided that I needed to take control of my life and quit depending on someone else to pay my bills. I decided to suck it up and sent the insurance company (STANDARD) a letter telling them that I had decided to go back to work because of their calls and letters, were causing me so much anxiety that I could not sleep and it was making my condition worst. I felt like I was being pushed to go back to work… I just can’t do it anymore… Is it too late? They send me the famous letter they send everyone I read about on in the internet… you will be evaluated by an unbiased doctor (at their discretion of course!) and you may have to pay the money back… anything to scare you off.

I have Fibro, Myofascial disease, back and neck injuries… have never been able to stop taking meds… too much pain and now my doc says that my severe migraines are now up there with arthritis… Am I too late? I received my last check like they said I would at the end of the 3 years, which according to them, is the length of time for Myofascial/Fibro disease coverage… What about all the other problems? Am I too late

I just cannot do this anymore… Lord knows I tried and do not like depending on anyone, but I came to the realization that I just cannot do this anymore… How do you work and what is your fee? My poor husband came back from Iraq and is trying to work, but all he could find was a $12 an hour job, so I am the main bread winner. He’s dealing with his own medical issues and after 25 years if service, we lost our medical insurance benefits so we have to pay a lot more for Medical Insurance. I am up against a rock and a hard place… Please advice.

Attorney Stephen Jessup:

Emesker,

If you have returned to work, depending on the time since you closed your claim, then you may have to file a new claim for benefits- that is if you are still covered under the Standard policy. Furthermore, if your conditions are subject to limited pay periods under the policy you may not be able to receive further benefits under the policy.

FrannieM:

Hi,

I have been on LTD with Liberty Mutual as the administrator for my prior employers policy. I am within 6 months of the end of the 24 month own occupation. My primary medical condition is RA with multiple articulations and other issues. My PCP says I should exercise daily to the best of my ability to help prevent other conditions from occurring or worsening. I have all my medical summaries for the most recent 12 months to provide Liberty. The most recent summary says to exercise.

I just got a packet from Liberty for the annual physician’s statement. I am complying with all my physicians recommendations, but I know Liberty does a lot of surveillance which they did during the STD period. I worry that when I take my daily walk Liberty will think I can do anything which I cannot due to damage to my hands and feet. It will become any occupation in 6 months. I was awarded SSDI after the initial required 5-month waiting period. I am concerned about providing too much detail on the question on my daily activities and why I cannot do any occupation. I read somewhere not to list every medical condition, but to focus on the primary diagnoses and not to say I cannot do “xyz” at all if I am able to do some things. But my current limitations do not allow me to meet the definition of sedantary according to SSA. Unfortunately, my medical issues had prevented me to a vast degree from being able to drive so I do not know how that applies to their decision.

Please let me know your thoughts. Thank you for your time and consideration.

Attorney Stephen Jessup:

FrannieM, providing detailed information about your daily activities/restrictions and limitations is very important at this point for various reasons – from advising that any exercise performed is a the direction/recommendation of your doctors to providing them the required concerning the impact of your medical conditions on your ability to work. Certainly focus on your main diagnosis, but it is important to address all medical conditions as your medical conditions all interact with one another affecting your ability to work. Please feel free to contact our office to discuss your claim in greater detail.

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