How does your long-term disability policy define “disability”?

On Behalf of | Jun 8, 2020 | ERISA Disability Benefits

Most long-term disability (LTD) policies are governed by the Employee Retirement Income Security Act (ERISA) — but that doesn’t mean that they’re all alike. In fact, one of the smartest things you can do before you try to file a claim is to make certain that you understand your LTD’s definition of what it means to be “disabled.”

Is it an “any occupation” or “own occupation” policy?

What’s the difference? Well, “any occupation” policies are generally quite restrictive. In order for them to kick in, you have to be able to show that you’re incapable of sustaining work activity in any profession — whether that’s just working at a call center for minimum wage or something else.

An “own occupation” policy is much more generous. It merely requires you to be unable to continue to perform your own job duties for some reason.

Some policies offer a two-tiered approach. They may start out as “own occupation” and remain that way for a year or two, then shift to “any occupation.” Reviewing your policy before you file can help you avoid an unexpected (and financially devastating) cut-off down the road.

Why do you need to keep the policy in mind from the start?

If you know that you have an “any occupation” policy, you want to start building the evidence that supports your claim early. This means being very specific about your limitations when you visit the doctor and making sure that your condition is clearly documented.

No matter what your limitations, it can be hard to get a long-term disability claim approved. Insurance companies are great about taking your premiums, but not so great about paying benefits when they are needed. If your ERISA claim has been denied, find out how an experienced advocate can help you navigate your appeal.