"What Can I Do to Stop My LTD Benefits Being Cut Off at the Change of Definition?"
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What is the Change of Definition?
In a long term disability claim, the Change of Definition usually refers to a change in the definition of what disability means in the insurance policy.
The Change of Definition usually occurs after you have been receiving benefits for 24 months. The change of definition usually refers to a transition from an "own occupation" definition to an "any occupation" definition. During the initial disability period, benefits are payable if you are unable to work at your "own occupation." After the change, benefits are payable only if you cannot work at "any occupation" for which you have the required education, skill, or experience. There are variations on the wording, but this summarizes the typical "change of definition".
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 other job. Your insurance company 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.
Once you reach the change of definition point, it can be difficult to change your insurer's mind, short of taking formal legal action, unless there is some dramatic medical evidence or change in your condition that makes it clear that you are totally disabled from working in any capacity.
Why do Insurance Companies Have this Change of Definition?
The change of definition was not created to benefit you. It gives your insurance company a reason to re-evaluate your 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 conditions affect 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. A lot of our clients have been cut off at the change of definition and we have had success at challenging these decisions by the insurance company.
What our Disability Insurance Lawyers Want you to Know
Any Occupation has to be a Similar Job at a Similar Pay Scale
The insurance company doesn’t care where you work, they simply want you off claim. However, if they are saying you can 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 company doesn’t want to pay you further. Your insurance company is saying you can find another job, but that is not the same as the reality of finding and keeping another job.
Finding a New Job When you Need Medical Accommodations Can be Challenging
When confronted with the idea of finding another job, you have to consider how your medical conditions affect your ability to work, the experience you need for the job, and 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. If you and your doctor agree that you should not return to work, you have several options for next steps.
While you can appeal the insurance company 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 long term disability claim. We recommend hiring a long term disability insurance lawyer to fight the insurance company instead of appealing your LTD denial.
What the Insurance Companies Don’t Want you to Know
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. If this happens, it is important that you find legal representation right away.
Keep in mind that the initial denial is only their interpretation of your case, using the expertise of their team of doctors to review your medical records, none of whom have your best interests in mind. Their concern is the savings they have if they don't pay your claim.
You can learn even more about the Change of Definition on our website, including what to do if your benefits have been cut off.
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A note from our long term disability lawyers
Taking a medical leave from work is not an easy decision to make. Concerns about providing for yourself and your family and keeping your job may cause you to want to push through your pain, but this won’t make your problems go away. Stopping work is often the smartest decision for your long term health and well-being, and your disability benefits are there to provide you with financial support until you can return to work.
If you have made the tough decision to stop working and apply for your short term disability or long term disability benefits, you may feel overwhelmed by the process and have questions that your employer and your insurance company are not able or willing to answer. Share is There to see you through and answer your questions.
Our disability law firm knows what you have been going through
We understand that things have not been easy for you over the last little while. Your health has been suffering, you are unable to work, and now your insurance company, who was supposed to be there in your time of need, has decided they will not pay your disability benefits or respect your disability claim. These benefits exist to provide you with the financial support you need so that you can focus on your health and rebuilding your life. It is unfortunate that your insurance company has not lived up to its promise. If your disability claim has been denied, we will fight to get you the benefits you are entitled to. Our disability lawyers have helped thousands of Canadians get their long term disability benefits over the past 35 years, and we can help you too.
Our experienced disability lawyers can fight back on your behalf
Share Lawyers believes that every client who is dealing with a disability claim deserves superior personal service. To achieve that goal, we have developed our team of experienced, compassionate, and caring long term disability lawyers, law clerks, and administrative staff to meet all of your needs. Our team of experienced long term disability, life insurance, employment, and critical illness insurance lawyers have made successful claims against many insurance companies, third-party administrators and employers.
If you are unable to work, your disability benefits should be there to provide you with the financial support you need. While your insurance company may be focused on finding ways to avoid paying your claim, our focus is on what is in your best interest. When Share Lawyers gets involved, you have an entire team of lawyers that are there to support you and to fight for what is yours.
Our disability claim lawyers fight for your disability insurance claim by relying on our many years of experience to apply the best strategic planning and approach in each case, using the latest technology available. Experience matters, and with Share Lawyers, you are in the best hands with 35 years of success on your side.
In this video, we explain the role of a long term disability lawyer and how we can support you when you have been denied your long term disability benefits.