{"id":3262,"date":"2020-12-28T20:26:57","date_gmt":"2020-12-28T20:26:57","guid":{"rendered":"https:\/\/nolfinal.wpengine.com\/?p=3262"},"modified":"2024-04-05T10:02:39","modified_gmt":"2024-04-05T15:02:39","slug":"long-term-disability-after-2-years","status":"publish","type":"post","link":"https:\/\/www.nickortizlaw.com\/long-term-disability-after-2-years\/","title":{"rendered":"Why Are Long-Term Disability Denials After Two Years So Common?"},"content":{"rendered":"\n<div class=\"wp-block-rank-math-toc-block\" id=\"rank-math-toc\" id=\"rank-math-toc\"><h2>Table of Contents<\/h2><nav><ul><li ><a href=\"#changes-in-the-definition-of-disability\">Changes in the Definition of Disability<\/a><ul><li ><a href=\"#how-insurance-companies-evaluate-transferable-skills\">How Insurance Companies Evaluate Transferable Skills<\/a><\/li><li ><a href=\"#the-ssa-says-i-am-disabled-so-why-was-my-ltd-claim-cut-off\">The SSA Says I Am Disabled, So Why Was My LTD Claim Cut Off?<\/a><\/li><\/ul><\/li><li ><a href=\"#benefit-limitations-for-specific-conditions\">Benefit Limitations for Specific Conditions<\/a><ul><li ><a href=\"#mental-nervous-conditions\">Mental\/Nervous Conditions\u00a0<\/a><\/li><li ><a href=\"#subjective-complaints-and-non-verifiable-impairments\">Subjective Complaints and\u00a0Non-Verifiable Impairments<\/a><\/li><li ><a href=\"#neuromuscular-musculoskeletal-and-or-soft-tissue-conditions\">Neuromuscular, Musculoskeletal, and\/or Soft Tissue Conditions<\/a><\/li><li ><a href=\"#conditions-related-to-alcohol-and-drug-abuse\">Conditions Related to Alcohol and Drug Abuse<\/a><\/li><\/ul><\/li><li ><a href=\"#appealing-a-long-term-disability-denial\">Appealing a Long-Term Disability Denial<\/a><\/li><li ><a href=\"#ortiz-law-firm-appeals-long-term-disability-denials-for-claimants-nationwide\">Ortiz Law Firm Appeals Long-Term Disability Denials for Claimants Nationwide<\/a><\/li><\/ul><\/nav><\/div>\n\n\n\n<p>Many people on <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/\" data-type=\"page\" data-id=\"3218\">long-term disability<\/a> worry about whether they will continue to receive benefits beyond the two-year mark, and for a good reason: <strong>Long-term disability denials after two years are common because most disability insurance policies change the definition of disability or will no longer pay benefits for certain conditions after benefits have been payable for two years.<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube youtube-embed wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Long Term Disability Insurance Claims - Why Are Claims Cutoff After Two Years?\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/VxoibQCtras?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"changes-in-the-definition-of-disability\">Changes in the Definition of Disability<\/h2>\n\n\n\n<p>The primary reason long-term disability benefits are cut off after two years is that under most disability policies, there is a change in how they <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/ltd-glossary-key-terms-in-policy\/\" data-type=\"page\" data-id=\"6209\">define the term disability<\/a>. Under most policies, for the first two years, you meet the definition of disability if you cannot perform the&nbsp;material duties&nbsp;of your occupation. This is often called the own occupation or \u201cown occ\u201d period because the insurance company determines whether you can perform your occupation.<\/p>\n\n\n\n<p>For instance, if you were working as an auto mechanic, that is considered your occupation. If you injure your back, you may not be able to work as a mechanic anymore because you cannot perform the job&#8217;s essential duties, such as bending, reaching, pulling, pushing, and using your back muscles in the way necessary to work on cars. However, in many policies, the definition of disability&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/own-occupation-vs-any-occupation\/\">changes from \u201cown occupation\u201d to \u201cany occupation\u201d<\/a>&nbsp;after two years or 24 months.<\/p>\n\n\n\n<p>The insurance company will look to see if you can perform the material duties of any occupation, often referred to as any occupation or \u201cany occ\u201d period. During a claim review under the \u201cany occupation\u201d 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 working in another field altogether.<\/p>\n\n\n\n<p>Therefore, in many cases, the insurance company will say:<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p>\u201cWe 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.\u201d<\/p>\n<\/blockquote>\n\n\n\n<p>This is why they often send letters cutting off long-term disability benefits after two years.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"how-insurance-companies-evaluate-transferable-skills\">How Insurance Companies Evaluate Transferable Skills<\/h3>\n\n\n\n<p>Insurance companies assess transferable skills through <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/ltd-glossary-key-terms-in-policy\/vocational-expert\/\" data-type=\"page\" data-id=\"6252\">vocational experts<\/a> to gain clarity on an individual&#8217;s abilities and their impact on claim decisions. These experts evaluate a person&#8217;s skills, experience, and education to determine if they can perform other types of work. They consider factors such as physical limitations, mental capabilities, and job market conditions to provide a <a href=\"https:\/\/www.nickortizlaw.com\/vocational-assessment\/\" data-type=\"post\" data-id=\"3220\">comprehensive assessment<\/a>. This process plays a crucial role in determining eligibility for benefits.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"the-ssa-says-i-am-disabled-so-why-was-my-ltd-claim-cut-off\">The SSA Says I Am Disabled, So Why Was My LTD Claim Cut Off?<\/h3>\n\n\n\n<p>The SSA requires claimants to prove that they are unable to engage in substantial gainful activity due to a medical condition expected to last <a href=\"https:\/\/www.nickortizlaw.com\/definition-of-disability-and-the-one-year-rule\/\" data-type=\"post\" data-id=\"3481\">at least one year<\/a> or result in death, but insurance companies usually define disability as the inability to perform the duties of one&#8217;s own occupation or any occupation for which the claimant is reasonably suited by education, training, or experience. This means claimants who qualify for Social Security Disability benefits may not necessarily qualify for LTD benefits.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"benefit-limitations-for-specific-conditions\">Benefit Limitations for Specific Conditions<\/h2>\n\n\n\n<p>The most common benefit limitations for specific conditions are those related to mental health claims. We also see limitations creep into the physical impairment category.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"mental-nervous-conditions\">Mental\/Nervous Conditions&nbsp;<\/h3>\n\n\n\n<p>Most group policies also <strong><a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/ltd-glossary-key-terms-in-policy\/mental-health-limitations\/\">limit how long a claimant can receive benefits for mental, nervous, and psychological impairments<\/a>.<\/strong>&nbsp;If you are receiving LTD payments due to&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/depression\/\">depression<\/a>,&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/anxiety\/\">anxiety<\/a>,&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/ptsd\/\">post-traumatic stress disorder<\/a>,&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/agoraphobia\/\">agoraphobia<\/a>,&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/obsessive-compulsive-disorder\/\">obsessive-compulsive disorder (OCD)<\/a>, 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.<\/p>\n\n\n\n<p class=\"blockquote\">Note: The rationale behind this two-year limitation on disability coverage from the insurance company\u2019s 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, it provides little comfort to those long-term disability recipients with bona fide mental illnesses whose benefits are terminated after only two years.<\/p>\n\n\n\n<p>There are often exceptions to this time limitation for organic mental disorders like&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/dementia\/\">dementia<\/a>&nbsp;and&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/organic-mental-disorders\/\">organic brain disease<\/a>, and perhaps even mental illnesses such as&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/schizophrenia\/\">schizophrenia<\/a>&nbsp;and&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/bipolar-disorder\/\">bipolar disorder<\/a>.&nbsp;<strong>The specific language in your policy determines which conditions are subject to the two-year limitation and which are exempt from this limitation.<\/strong>&nbsp;Policies offered by different insurance companies will use different language to describe the terms of the disability policy.<\/p>\n\n\n\n<p>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 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.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"subjective-complaints-and-non-verifiable-impairments\">Subjective Complaints and&nbsp;Non-Verifiable Impairments<\/h3>\n\n\n\n<p>Some policies also have a two-year limit on long-term disability benefits for chronic pain conditions such as&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/arthritis\/\">arthritis<\/a>&nbsp;and chronic&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/back-pain\/\">back pain<\/a> and for medical conditions that are primarily diagnosed based on &#8220;subjective,&#8221; <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/ltd-glossary-key-terms-in-policy\/self-reported-symptoms-limitation\/\" data-type=\"page\" data-id=\"6246\">&#8220;self-reported<\/a>,&#8221; or &#8220;non-verifiable&#8221; complaints, including&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/chronic-fatigue-syndrome\/\">chronic fatigue syndrome<\/a> and&nbsp;<a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/medical-conditions\/fibromyalgia\/\">fibromyalgia<\/a>. However, some insurance policies may carve out exceptions to this limitation. <\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"neuromuscular-musculoskeletal-and-or-soft-tissue-conditions\">Neuromuscular, Musculoskeletal, and\/or Soft Tissue Conditions<\/h3>\n\n\n\n<p>Your policy may also state that benefits are limited to 24 months for <a href=\"https:\/\/www.nickortizlaw.com\/long-term-disability-claims-for-neuromuscular-disorders\/\" data-type=\"post\" data-id=\"8605\">neuromuscular<\/a>, <a href=\"https:\/\/www.nickortizlaw.com\/long-term-disability-claims-for-musculoskeletal-disorders\/\" data-type=\"post\" data-id=\"7195\">musculoskeletal<\/a>, and\/or <a href=\"https:\/\/www.nickortizlaw.com\/long-term-disability-claims-for-soft-tissue-disorders\/\" data-type=\"post\" data-id=\"8594\">soft tissue conditions<\/a>. Understanding your policy&#8217;s terms and conditions is crucial. <\/p>\n\n\n\n<p>For example, I have seen a MetLife policy with a 24-month limit on neuromusculoskeletal and soft tissue disorders, except where there is certain objective evidence. Working with medical professionals who understand these details can strengthen your claim.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"conditions-related-to-alcohol-and-drug-abuse\">Conditions Related to Alcohol and Drug Abuse<\/h3>\n\n\n\n<p>Disabilities caused or contributed to by alcohol or drug abuse will almost always be subject to the same 24-month limitation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"appealing-a-long-term-disability-denial\">Appealing a Long-Term Disability Denial<\/h2>\n\n\n\n<p>If your long-term disability benefits get cut off after two years, you must <a href=\"https:\/\/www.nickortizlaw.com\/practice-areas\/long-term-disability-insurance-erisa-lawyer\/appeals\/\" data-type=\"page\" data-id=\"77\">file an appeal<\/a> within the specified time frame cited in the letter. Your denial letter should clearly state the deadline, which is usually 180 days from the date of the denial letter. Missing your long-term disability appeal deadline is a <a href=\"https:\/\/resources.nickortizlaw.com\/free-ltd-book\">common mistake<\/a> that could destroy your claim. Given the complexities of long-term disability claims, having the right legal support can be the key to filing a timely appeal and securing the benefits you rightfully deserve.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"ortiz-law-firm-appeals-long-term-disability-denials-for-claimants-nationwide\">Ortiz Law Firm Appeals Long-Term Disability Denials for Claimants Nationwide<\/h2>\n\n\n\n<p>Long-term disability attorney <a href=\"https:\/\/www.nickortizlaw.com\/about-us\/our-team\/nick-ortiz\/\" data-type=\"page\" data-id=\"3656\">Nick Ortiz<\/a> has been advocating for the disabled since 2005 and understands the <a href=\"https:\/\/www.nickortizlaw.com\/insurance-company-tricks-and-tactics\/\" data-type=\"post\" data-id=\"3301\">sneaky tactics<\/a> used by insurance companies to deny claims. We handle claims with disability insurance companies such as <a href=\"https:\/\/www.nickortizlaw.com\/insurance-companies\/new-york-life\/\">New York Life<\/a>,\u00a0<a href=\"https:\/\/www.nickortizlaw.com\/insurance-companies\/lincoln\/\">Lincoln Financial<\/a>,\u00a0<a href=\"https:\/\/www.nickortizlaw.com\/insurance-companies\/reliance-standard\/\">Reliance Standard<\/a>,\u00a0<a href=\"https:\/\/www.nickortizlaw.com\/insurance-companies\/prudential\/\">Prudential<\/a>, and\u00a0<a href=\"https:\/\/www.nickortizlaw.com\/insurance-companies\/hartford\/\">The Hartford<\/a>. We can assist you in gathering your documents and statements from your doctors, reviewing your claim, and even hiring vocational experts to speak on your behalf. If you want to discuss your long-term disability claim with an attorney, please call us at <strong><a href=\"tel:8883218131\">(888) 321-8131<\/a><\/strong> or contact us online.<\/p>\n\n\n\n<a class=\"button large\" href=\"https:\/\/www.nickortizlaw.com\/contact\/\">Get a Free Case Review<\/a>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Many people on long-term disability worry about whether they will continue to receive benefits beyond the two-year mark, and for a good reason: Long-term disability denials after two years are common because most disability insurance policies change the definition of disability or will no longer pay benefits for certain conditions after benefits have been payable &hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[207,210],"tags":[],"_links":{"self":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/3262"}],"collection":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/comments?post=3262"}],"version-history":[{"count":0,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/posts\/3262\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/media?parent=3262"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/categories?post=3262"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nickortizlaw.com\/wp-json\/wp\/v2\/tags?post=3262"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}