Different Definitions of Disability in Long-Term Disability Insurance Policies

Different Definitions of Disability in Long-Term Disability Insurance Policies

The term “disability,” as used in a long-term disability insurance policy, refers to the criteria that the insurance company uses to determine whether you are eligible for disability payments or not. Each policy defines disability specifically for that policy, so there is no universal definition of the term. Therefore, it is essential to read your insurance policy to make sure that you are eligible for benefits before applying for them.

For instance, some insurance policies require you to be disabled for your “own occupation” to be eligible for long-term disability insurance benefits. Disability based on own occupation means that your medical conditions make you unable to perform the primary job duties of your specific position. In many cases, insurance companies use this definition of disability to determine eligibility for the first 24 months of long-term disability benefits.

Another standard definition of disability requires proof that your medical conditions make you unable to work in “any occupation.” This definition means that you are unable to perform the fundamental job duties of any positions for which you are qualified through your education, training, and experience. Some insurance policies switch to this definition of disability for continued eligibility for benefits after claimants have received 24 months of benefits. This is a far more difficult standard to meet than that of disability based on “own occupation.” This changing definition of disability within a single policy often is referred to as split definition coverage. We call this the “own occ/any occ provision.”

Other insurance policies provide long-term disability coverage only in the event of catastrophic impairment, whether by injury or illness. In this case, individuals must be unable to perform activities of daily living, such as bathing, feeding, and getting dressed without assistance.

Bonnici Law Group provides client-focused representation throughout the ERISA claims process. We are here to consider the evidence in support of your ERISA long-term disability claim, evaluate your claim, and develop the most effective strategy for fighting any denials of coverage that you may receive. Allow us to handle your legal needs while you focus on your physical and emotional health. Contact the ERISA long-term disability attorneys of Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

Write a Reply or Comment