Every LTD insurance policy is different, so the definition of disability for the purposes of receiving LTD benefits also varies. For example, some policies will list specific medical conditions that automatically make you disabled and eligible for disability benefits, such as amputations, blindness, or deafness. If your condition doesn’t automatically qualify you for benefits, then you must qualify for benefits according to the definition of disability in your particular policy.
Some disability policies establish an “own occupation” definition of disability. In this situation, you must prove that your medical condition, injury, or illness, prevents you from performing the essential tasks of your own occupation. That is, based on your job description and daily job duties, your condition does not allow you to successfully complete all those tasks. This is a less strict definition of disability, however, than in some other LTD insurance policies.
The stricter definition of disability found in some LTD insurance policies concern “any occupation.” In other words, this definition asks whether you can perform any type of job duties for which you are qualified, even with your medical condition, injury, or illness. This definition ignores whether you traditionally have worked in a skilled profession; arguably, if you can perform a secretary’s job despite your disabilities, then you may not be not disabled and entitled to LTD benefits, even if you previously worked as a lawyer or a doctor. As long as you are “qualified” to work a job, then you may not be disabled under the terms of your LTD policy.
Some insurance policies use both the “own” and “any” definitions of disability. For example, your LTD policy initially may allow you to draw benefits based on your “own occupation.” However, after you draw a set number of months of benefits, then your policy may require you to prove that you meet the “any occupation” definition of disability. This change in standards can lead to termination of your LTD benefits.
You also should keep in mind that not all medical conditions or “disabilities” are created equal in the world of LTD benefits. For example, LTD policies often only allow claimants to draw benefits for “mental or nervous conditions” for a limited period, such as 24 months. After that time, you are no longer disabled for the purposes of receiving LTD benefits.
Bonnici Law Group has handled the claims of countless individuals who have encountered difficulties in procuring long-term disability benefits under their employers’ ERISA-governed insurance policies. We will protect your rights and advocate on your behalf throughout every stage of the claims process. Call our office at 619-259-5199 to set up an appointment to speak with us today.