One provision in long-term disability insurance policies that often takes individuals by surprise is the fact that the policy’s definition of disability for the purposes of qualifying for benefits often changes over time. In many cases, the change in disability definitions after an individual has been receiving benefits for a certain time period triggers an unexpected termination in the payment of benefits.

In most employer-sponsored disability plans that are subject to the Employee Retirement Income Security Act of 1974 (ERISA), the payment of benefits is based on a definition of disability relevant to your own occupation at the time you became disabled. In other words, you are disabled for the purposes of receiving disability benefits so long as you can prove that you no longer can perform the essential tasks required for the specific job that you held when you became disabled.

After you have received disability benefits based on this definition of disability for a certain timeframe, however, the definition of disability can suddenly change to one that requires a higher standard and different definition of disability. Typically, the definition changes to whether you are able to perform any type of job that exists in the national economy – with taking into account for the claimant’s income, education and job history. If there is a job that you can perform, despite your current medical condition, then you may no longer be disabled for the purposes of receiving disability benefits through your employer-sponsored plan. This clause is often referred to as the “own occ/any occ” provision.

It is extremely common for insurance policies to change the required definition of disability after individuals have received 24 months of disability benefits, or, in some cases, only 12 months of benefits. In many cases, this change in definition causes your insurance company to review your eligibility for benefits and find that you are no longer disabled within the required definition of disability. It is at the end of the “own occupation” period where most denials occur, even when the medical condition of the claimant hasn’t changed at all.

At Bonnici Law Group, we offer you client-centered representation at all stages of the long-term disability benefit claims process. When you need the kind of help that only an experienced long-term disability benefits attorney can offer you, contact Bonnici Law Group at 858-261-5454 or help@bonnicilawgroup.com.