When a mental or physical disability challenges your ability to continue performing the duties of your occupation, you may be tempted to do anything you can to continue working. You may, for instance, work through the pain or modify the duties of your occupation to accommodate your disability. But it’s important to know that these can be costly decisions. When you finally decide to file for long-term disability benefits, your insurance company will exploit your heroic efforts to keep working through the disability and use it against you to deny your claim.
Review How Disability Is Defined in Your Policy
Long-term disability insurance policies may define disability either as an inability to perform the duties of “any occupation” or your “own occupation.” An “any occupation” LTD policyholder will not be considered totally disabled, and therefore will not be entitled to benefits, if they are able to perform the duties of “any occupation,” as defined in their policy. Generally “any occupation” is defined as a position for which the individual is reasonably suited based on their education, skills, experience and other factors. By contrast, “own occupation” policies consider the individual to be disabled if they can no longer perform the material duties of their specific occupation. Most employer-sponsored disability policies are of the “any occupation” variety, while “own occupation” policies are particularly common among high-income earners, such as doctors, dentists or attorneys.
The Insurer May Manipulate the Duties of Your Occupation
Many people who suffer from a physical or mental disability will attempt to modify their duties to accommodate their disability. For example, say a busy heart surgeon with an “own occupation” policy suffers from a severe spinal condition. She realizes she can no longer safely perform heart surgery, so she limits her practice to only performing cardiac consultations because they are not as physically demanding. Upon filing her claim, she learns that the insurance carrier is denying her total disability due to the fact that she performed cardiologic consults as part of her previous occupation as a heart surgeon, and she continues to perform them. The carrier will reason that cardiac consults were an “important” or “substantial” part of her previous occupation and pay her a reduced benefit, or no benefit at all.
If the above physician had stopped practicing altogether when she realized she could no longer safely perform heart surgeries, the probability of her receiving total disability benefits would have been greatly enhanced.
If You Keep Working Through Pain, the Insurer Will Say You’re Not Disabled
Many of our clients choose to work through their pain long after they are diagnosed with a significant ailment. Long-term disability insurance companies will use this fact to the claimant’s detriment.
For example, Billy is the CEO of a large corporation that he founded. He has 300 loyal employees who depend on him for direction, advice and their paychecks. Billy is diagnosed with severe postural orthostatic tachycardia (POTS). POTS is a disease characterized by unpredictable bouts of severe dizziness, cognitive issues, heart palpitations and profound fatigue. Despite this dire diagnosis, Billy chooses to press on as CEO of the company he built. A year subsequent to the diagnosis, he realizes that he can no longer continue to perform the important duties of his occupation as a CEO due to his significant physical and mental restrictions.
Here, the long-term disability insurance company will reason that he was able to work with POTS for a year (or longer) and that his condition and diagnoses have not changed. To the insurance company, this is proof positive that he is not disabled. The insurance company will use this as one of the bases to deny his total disability claim.
Had Billy decided to stop working and file a claim as soon as he realized he was physically and mentally unable to perform his duties as a CEO, his claim for benefits would have been much stronger. By being a hero, he prejudiced his own claim.
Don’t Be a Hero Like Billy
If you are no longer able to perform the duties of your occupation due to a debilitating physical or mental condition, you may be tempted to grit your teeth through the pain or to modify your duties in order to continue working. But it’s important to understand that doing so can and will harm your disability claim when you finally decide to file one.
Give careful consideration to the date when your illness or injury began limiting or preventing you from performing your job duties. This is considered the trigger date for coverage. As many disabling conditions gradually get worse, you may need to carefully analyze your activity levels over time and consult with your doctor to pinpoint your trigger date. Many policies strictly limit the amount of time you have after the trigger date to file or give notice of your claim.
If you have questions about when you should consider filing a long-term disability claim, please do not hesitate to contact us with any questions or issues you may have.
