Did you receive a letter notifying you of a change of definition in your long-term disability benefits (LTD)? Maybe, your injury or illness requires ongoing long-term care and you need to initiate the process.
Before starting the court processes for definition changes, understanding what this means for your current and future benefits can help ensure everything goes smoothly and you’re not left with any gaps in your coverage.
What is a Change of Definition
Even though you initially qualified for long-term disability benefits, insurance companies can alter the criteria. This may mean you no longer meet certain terms required to continue receiving financial benefits. Why does a change of definition occur?
A change of definition is normal for anyone receiving disability benefits. Instead of continuing to approve your claim, insurance companies often change the definition of your occupation. The insurance company agrees your injury or illness prevents you from returning to your previous occupation, however, they believe you can find employment in another industry.
The change of definition, essentially, is a way for insurance companies to try and end your disability coverage. Most insurance providers wait around two years before alerting you of an upcoming change of definition. However, some insurers will let you know of a possible change of definition when you start receiving benefits.
Regardless of when you’re notified, don’t automatically accept the change of definition. You can take steps to help ensure you continue receiving financial benefits for your work-related injury or illness.
Changing From Own to Any Occupation
A change in definition typically means the insurer is making a small adjustment in your coverage. Instead of listing your benefits as your occupation it changes to any occupation.
In simple terms, your original coverage is for the position you retained at the time of your illness or injury. Your benefits cover your lost income based on the position. These benefits typically last for two years before the change of definition goes into effect.
The change to any occupation is regulated by the courts. In other words, the definition of “any occupation” isn’t as broad as you may fear. For example, if your previous occupation is in the data industry the insurance company can’t claim a position in a fast food restaurant qualifies as “any occupation”.
The courts mandate that “any occupation” must allow you to earn at least 75% of your previous income. There can be exceptions. If you decide to file a claim against the insurance company’s change in definitions in court, a judge can decide that an occupation providing around 60% of your income is reason enough to terminate your benefits.
You must also have training or experience in “any occupation”. Since most insurance companies are unlikely to pay for training, it can limit your job choices.
In most cases, having limited employment opportunities is a downside but it’s different when you’re dealing with a change of definition. Doing so can help prove your eligibility for continued long-term disability benefits.
Impact on Your Benefits After Receiving a Notice of Change of Definition
So, what happens to your benefits after receiving a notice of a change of definition? Thankfully, you shouldn’t notice any changes for the first few months. During this time, the insurance company is talking to your healthcare provider and reviewing your medical records. You may be required to attend assessments. These can be either medical, skill, or both.
The goal of the assessments is to evaluate your medical condition and determine what skills translate to another occupation. Unfortunately, some insurers conduct assessments without notifying you. While this is legal, the insurance company’s assessment may not be an accurate reflection of your skill set or medical condition.
Don’t be surprised if you receive a notification from the insurance company notifying you of the upcoming end of your long-term benefits. This is normal and the insurance company is hoping you’ll accept the decision. You can fight the termination of your LTD benefits by filing a claim in civil court.
How Legal Representation Can Help Ensure You Continue Receiving LTD
Insurance companies rarely look forward to paying out long-term claims. If you receive a notification of a change of definition or you need to make adjustments to your current benefits, don’t go through the legal process alone.
A well-versed attorney can review your options if you’ve received a notification. If you need to initiate the change of definition, an attorney can also walk you through the process. If your claim is approved, your attorney can help you navigate the next steps to help ensure that your benefits continue uninterrupted.
