Change of Definition

In a long term disability claim, the change of definition refers to a change in the definition of what it means to be disabled according to your disability policy. Commonly you will see that this takes place after 24 months of being on long term disability. Where previously the insurance companies have looked at your ability to go back to doing your job, they are now looking to see if you can do “any occupation”. Your insurance provider may try and define this very loosely stating that if you can earn minimum wage working a job for example as a parking attendant, then you have the ability to work and are not entitled to your disability benefits further. The insurance company doesn’t care where you work, they simply want you "off claim". However, if they are saying you can’t work, it has to be at a job that’s at a similar skill level to what you were doing and at a similar pay scale. If you can’t do that, they should continue to pay your long term disability benefits. You have worked very hard and should not have to sacrifice because your insurance provider doesn’t want to pay you further.

The change of definition was not created to benefit you. It gives your insurance company a reason to re-evaluate your disability claim, to find reasons to stop payment. However, your insurance company saying you can find another job compared to actually getting another job is very different. You have to consider how your medical condition impacts your ability to work, the experience you need for the job, and the accommodations you would need to be able to work. It will be very difficult to be hired if you are asking for accommodations prior to employment.

You should not accept their decision to decline your disability benefits and it’s important that you fight it with the help of an experienced disability lawyer and law firm. A lot of our clients have been cut off at the change of definition and our law firm had had success at challenging these decisions by the insurance company.

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If you have been denied long term disability benefits at your change of definition, it can be difficult to change your insurance company's mind. Taking legal action may be the best way for you to get your disability benefits. While you can appeal their decision, unless there is some dramatic medical evidence or change in your condition that makes it clear that you are not able to work in any capacity, they will continue to deny your disability claim. Many insurance companies believe that very few people qualify for benefits in the “any occupation” period, basing their adjudication on a paper review by their doctors, none of whom have your best interests in mind. Your insurance company’s concern is the money they can save by stopping payment to you. We can put our over 35 years of experience to work for you and help you win back the benefits you deserve.

You do not have to quit your job, nor should you. Just because you can’t work right now, doesn’t mean that you won’t be able to return to work at some point. Your insurance company is not looking for you to go back to your existing job, but their expectation is that you will find work elsewhere. It is important to remember that you should not be forced to find other work. You should contact our team of disability lawyers and employment lawyers to find out how we can fight your insurance company’s decision to deny your long term disability benefits.

Your insurance company may want to have one of their doctors conduct an examination and get their opinion about your capabilities at the change of definition. While an IME is meant to provide an unbiased opinion, your insurance company will use doctors that they believe will validate the opinion they have already formed. They typically use the same doctors over and over to have some control over the outcome of the report. Keep in mind that the IME doctor’s opinions do not override your doctor’s opinions regarding what’s best for you.

Their doctors are not looking out for what is in your best interest, they simply want a reason to cut off your disability benefits and that is the only thing that they have control over. If your doctors support you continuing to be off work due to your medical condition(s), you should continue to follow the advice of your doctors, as it is their duty and job to look out for your best interests. You and your doctors may be confused as to how the insurance company gives greater credit to an IME doctor’s opinion than your own treating doctors, but this is done all the time. If your insurance company cuts off your benefits following an IME then our disability law firm can help.

At the change of definition, your insurance company may want to know what skills you have to see if they can determine other work you are capable of doing. A TSA will review your resume for your previous work experience, skills, and education. When long term disability benefits are denied at the change of definition, your insurance company’s letter to you will often list jobs identified by a TSA that they feel you should be able to do. Just because they have listed these jobs doesn’t mean you are capable or experienced to do such work, and returning to work may require extensive retraining and reconditioning to have any chance of success. You should not be intimidated by this analysis, as the findings are frequently flawed, incomplete, or inaccurate.