{3:20 minutes to read} Contained in your disability insurance policy you will find an occupational definition – read it!
Some policies have an “own occupation” clause only, stating the insurance company will pay you through the life of your policy if you cannot perform the duties required to do your job. Other policies pay only if you are disabled and unable to perform the duties of “any occupation.”
A typical “any occupation” definition states: We will only find you totally disabled if you are unable to perform any occupation for which you are reasonably fitted by education, training or experience.
If that definition started out as an “own occupation” definition and it is going to change to an “any occupation” definition, you need to know what happens next and what you should do.
When the insurance company notifies you that the definition is about to change, it is an indication that they are planning to scrutinize your claim to determine whether or not you still meet the definition of disability and therefore, whether the insurance company believes you are still entitled to receive benefits.
This means the insurance company will be examining medical records; vocational records; work you are currently performing if any; restrictions and limitations; doctor’s statements; etc. Then they will decide whether or not they believe you are currently able to work in any occupation. They may do this without asking you for any input. As a result, you could receive a letter without any prior notice stating that your disability benefits are terminated. Knowing what the insurance company is going to do, you need to beat them to the punch and do it first.
Here’s what you need to do to prepare:
- Check with doctors to make sure they are going to support the fact that you cannot work in any occupation.
- If possible, get a vocational expert to evaluate you in the context of your medical condition, to determine whether or not they think you can work in any occupation.
- Think about what you will tell the insurance company regarding your inability to work in any occupation, as defined in your policy, and either explain it in a letter or be prepared to do so.
If you do not act, it is almost certain the insurance company will. They will decide whether or not you meet the definition in your policy. You can dramatically increase your chances that your benefits are not going to be terminated by being proactive. If that definition changes or you know that it’s about to change, be prepared to take immediate, preventive action.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schwartzlawpc.com