There is a reason why many people receiving long-term disability benefits become concerned about their coverage after two years: most long-term disability insurance policies have a number of limitations that allow the insurance company to terminate certain claims after benefits have been payable for twenty-four months or two years.
Changes in the Definition of Disability
The primary reason why long-term disability benefits are cut off after two years is that under most disability policies, there is a change in the way that they define the term disability. Under most policies, for the first two years, you meet the definition of disability if you cannot perform the material duties of your occupation. This is often referred to as the own occupation or “own occ” period because the insurance company looks at whether you can do your own occupation.
For instance, if you were working as an auto mechanic, that is considered your own occupation. If you injure your back, you may not be able to work as a mechanic anymore because you cannot perform the essential duties of that job such as bending, reaching, pulling, pushing, and using your back muscles in the way that is necessary to work on cars.
However, in many policies, the definition of disability changes from “own occupation” to “any occupation” after two years or 24 months. The insurance company will look to see if you can perform the material duties of any occupation, often referred to as any occupation or “any occ” period. During a claim review under the “any occupation” standard, typically after two years of receiving long-term disability benefits, the insurance company will look to see if you can work any occupation. This could be working as a salesman or secretary in the auto body shop instead of a mechanic, or it could mean working in another field of work altogether.
Therefore, in many cases, the insurance company will say, “We agree that given your medical problems you cannot perform the material duties of your job, but after two years, we think that there are other types of work that you may be able to perform, even taking into account your medical condition.” This is why they often send a letter cutting off long-term disability benefits after two years.
Limitations for Specific Conditions
Mental/Nervous Conditions
Most group policies also have a limitation on how long a claimant can receive benefits for mental, nervous, and psychological impairments. If you are receiving LTD payments due to depression, anxiety, post-traumatic stress disorder, agoraphobia, obsessive-compulsive disorder (OCD), or a similar impairment, you may be limited to receiving 24 months of benefits. However, if you are institutionalized or confined to an inpatient treatment facility when your 24 months expire, most insurance companies will continue to pay benefits until you are no longer hospitalized, subject to a cap.
Note: The rationale behind this two-year limitation on disability coverage from the insurance company’s point of view is that many of these mental/nervous impairments can be exaggerated or outright faked. There is a possibility that the claimant is pretending to be unable to perform any occupation. While this policy does keep insurance policy premiums lower, this provides little comfort to those long-term disability recipients with bona fide mental illnesses whose benefits are terminated after only two years.
There are often exceptions to this time limitation for organic mental disorders like dementia and organic brain disease, and perhaps even for mental illnesses such as schizophrenia and bipolar disorder. The specific language in your policy determines which conditions are subject to the two-year limitation and which are exempt from this limitation. Policies offered by different insurance companies will use different language to describe the terms of the disability policy.
If you also suffer from a physical condition, your insurer may try to say that your mental health issues are the sole cause of your disability A disability attorney can help you determine if a mental health limitation applies to your claim. If the insurer has inappropriately applied a mental health limitation to your claim, your attorney can help you appeal the decision.
Subjective Complaints and Non-Verifiable Impairments
Besides limitations for mental health impairments, we are seeing limitations creep into the physical impairment category.
Some policies also have a two-year limit on long-term disability benefits for chronic pain conditions such as arthritis and chronic back pain, and for medical conditions that are primarily diagnosed based on “subjective” or “non-verifiable” complaints, including chronic fatigue syndrome, neuromusculoskeletal and soft tissue disorders, and fibromyalgia. However, some insurance policies may carve out exceptions to this limitation. For example, I have seen a MetLife policy that has a 24-month limit on neuromusculoskeletal and soft tissue disorders, except where there is certain objective evidence.
Conditions Related to Alcohol and Drug Abuse
Disabilities caused or contributed to by alcohol or drug abuse will almost always be subject to the same 24-month limitation.
Appealing A Wrongful Termination of Your Long-Term Disability Claim
If your long-term disability benefits are cut off after two years, it’s essential to file an appeal within the time required by the cutoff letter. Therefore, it’s crucial to contact an experienced attorney to help walk you through how you can appeal the decision and prove that your disability not only keeps you from doing your job, or your own occupation, but that it keeps you from being able to do any job or “any occ”. If your LTD benefits have been cut off by the insurance company after this 24-month period, then I encourage you to contact an experienced LTD attorney.
Your cutoff letter should specify a certain time within which you have to file any appeals. In most cases, it’s 180 days from the date of the letter. You should make sure to file your appeal within that time, as the failure to do so is a common mistake that people make while fighting for long-term disability benefits. There are other common mistakes that people make, and that’s why I wrote a book called the Top 10 Mistakes That Will Destroy Your Long-Term Disability Claim.
The best way to fight the insurance company is to use an experienced long-term disability attorney. The Ortiz Law Firm knows all about the insurance companies’ sneaky tactics to cancel claims. We handle claims with Cigna/New York Life Group Benefit Solutions, Unum, MetLife, Lincoln Financial, Hartford, Principal, and any of the other major disability insurance companies. We can help you gather your documents and statements from your doctors, review your claim, and even hire vocational experts to speak on your behalf. If you want to talk to an attorney about your long-term disability claim, please give us a call at (888) 321-8131. We look forward to hearing from you.
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