Own Occupation v. Any Occupation
The primary reason why benefits are cut off after two years is that under most policies there’s a change in the way that they’ve defined the term disability. Under most policies, for the first two years, you are disabled so long as you cannot perform the material duties of your occupation. This is oftentimes referred to as the own occupation or “own occ” period because they’re looking at whether you can do your own occupation.
But also under most policies, after two years or 24 months of benefits, the definition changes such that they look to see whether you can perform the material duties of any occupation, and that’s oftentimes referred to as the any occupation or “any occ” period. 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.” That’s why they oftentimes will send you a letter cutting you off at the two-year mark.]
Time Limitation on Mental / Nervous Conditions and Disabilities Diagnosed by Subjective Complaints
Most group policies have a 24-month limitation for claims involving disabilities arising from 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 (from the insurance company’s point of view) is that many of these mental/nervous impairments can be exaggerated or outright faked. While this policy does keep insurance policy premiums lower than they otherwise would be, this provides little comfort to those LTD recipients with bona fide mental illnesses whose benefits are terminated after only two years.
There are often (but not always) 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. You must look to the specific language in your policy to determine what conditions are subject to the two-year limitation (and to determine which conditions are exempt from this 24-month limitation).
Some policies also have a two year for chronic pain conditions such as arthritis and chronic back pain, and for medical conditions that are primarily diagnosed based on “subjective” complaints, including chronic fatigue syndrome, neuromusculoskeletal and soft tissue disorders, and/or fibromyalgia. Again, some insurance policies may carve out exceptions to this limitation. For example, I’ve seen a MetLife policy that has a 24 month limit on neuromusculoskeletal and soft tissue disorders, except where there is certain objective evidence. Here is an excerpt from that policy:
Neuromusculoskeletal and soft tissue disorder including, but not limited to, any disease or disorder to the spine or extremities and their surrounding soft tissue; including sprains and strains of joints and adjacent muscles, unless the Disability has objective evidence of
- seropositive arthritis;
- Spinal tumors, malignancy, or vascular malformations;
- traumatic spinal cord necrosis; or
Finally, disabilities caused by alcohol or drug abuse will almost always be subject to the same 24-month limitation.
Appealing the Decision to Cutoff Your Claim After 2 Years
If you are cut off after two years, it’s very important that you file an appeal within the time required by the cutoff letter. That’s why it’s important to contact an experienced attorney to help walk you through how you can appeal the decision, and how you can 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.
Now, 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. 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. I encourage you to download a free copy of this book, or if you want to talk to someone right away, please give us a call at (866) 853-4512. We look forward to hearing from you.