Why Is My Long Term Disability Reviewing Me Again
Reasons for Denial of Long-Term Disability After Ii Years
When you filed for your long-term inability (LTD) benefits, you likely had to testify that you were totally disabled. Well-nigh insurance companies ascertain "totally disabled" as being unable to perform the essential tasks necessary to do your own job.
Information technology has now been two years since yous were approved for long-term disability benefits, and the insurance visitor has notified you that it is re-evaluating your eligibility for long-term disability benefits. Aught has changed regarding your condition in the past ii years, and so why is the insurance company cut off benefits now? Our Kansas City long-term disability lawyer explains why this might be happening in your case.
The Definition of Disabled Changes After Two Years from "Own Occupation" to "Whatever Occupation"
Being re-evaluated means that y'all must get through the process of proving that you lot are disabled once again. Why is the insurance company doing this afterward two years?
For most long-term disability insurance policies, yous run into the definition of being totally disabled for the first two years if you lot cannot perform the duties required to do your "own" job. This standard is referred to as the "Own Occupation Exam." The start two years you lot receive long-term inability benefits are often referred to every bit the "own occ" menses of the policy.
For example, a construction worker injures his back. Considering of the back injury, the construction worker cannot curve and lift objects. Therefore, the insurance company determined the worker was totally disabled considering he could not perform the fabric tasks required to perform his own job.
However, afterward two years, the criteria for being totally disabled shifts to an "Whatsoever Occupation Test" or "any occ" menses. The insurance visitor re-evaluates your claim to decide if your disabling condition allows yous to perform the job duties for any occupation. Instead of limiting the consideration to the task duties required to perform construction piece of work, the insurance visitor evaluates yous based on whatsoever chore.
For instance, the insurance visitor might country that you cannot bend and lift heavy objects to perform construction work, but you lot could piece of work at a desk reviewing structure drawings or ordering supplies. However, the evaluation is non limited to just your field of work. The insurance company can evaluate your ability to perform work in any field to decide if you see the definition of totally disabled after two years.
There could exist other reasons the long-term inability insurance visitor is denying long-term inability benefits.
Two Year LTD Limits for Sure Disabling Conditions
Your long-term disability benefits may end after ii years based on the type of disabling condition you have that resulted in long-term disability payments. For instance, most long-term disability insurance policies place a 2-twelvemonth limit on disabilities resulting from drug abuse or alcohol abuse.
These group policies also have a two-twelvemonth limit on long-term disability benefits for many disabilities based on nervous, mental, or psychological impairments. That would include disability benefits based on PTSD (post-traumatic stress disorder), low, anxiety, and other mental and emotional disorders.
The reasoning is that many of these disorders can exist "faked" or exaggerated. You can receive up to 24 months of long-term inability benefits and then the benefits finish. However, if yous are receiving inpatient handling for the condition, the insurance company might continue to pay benefits until yous reach a cap for benefits.
In some cases, there could be exceptions to the 2-year limitation on mental disorders. Suppose you have proof that you endure from an organic brain disorder or neurocognitive disorder, such every bit Bi-Polar disorder, dementia, or schizophrenia. In that case, you lot could receive long-term disability benefits past the two-year cutoff. Nevertheless, y'all volition need medical proof that you lot suffer from i of the conditions exempted from the two-year limitation.
Many long-term disability insurance policies also include a two-year limitation for benefits paid for chronic pain disorders and other wellness conditions based on subjective symptoms such as fibromyalgia and chronic fatigue syndrome. The limitation may include many soft tissue and neuromusculoskeletal disorders. Some policies may include an exemption for certain disorders that have objective medical show to support the disability.
Long-term Disability Insurance Defines Disability Differently from the Social Security Administration
Many individuals are shocked when their LTD benefits terminate because they were approved for disability benefits nether Social Security. However, the Social Security Administration's definition of disabled is different from the criteria used by long-term disability insurance companies to decide if you are disabled.
A person may be eligible for Social Security disability benefits if they cannot perform the work they did earlier developing a disabling condition, the condition is expected to final at least i year or longer, and they cannot arrange to other work because of their disability.
However, long-term inability insurance companies are not required to use this definition of disabled. Therefore, your long-term disability benefits may be terminated nether the insurance policy even though the Social Security Administration ruled that yous were disabled based on their criteria for totally disabled.
How Can the LTD Insurance Company Prove I Can Work Subsequently Two Years?
The insurance company hires a vocational good to review your instance. A vocational expert performs a Transferable Skills Analysis or TSA based on the information in your file. The TSA is a calculator analysis used to determine what skills you have that could be transferable to another job. For example, do you take skills that could transfer to a job that requires petty physical labor (a sedentary task)?
The vocational adept creates a report that outlines your power to perform concrete labor. Suppose the TSA finds that you tin transition into a sedentary job. In that case, the report lists jobs that you are qualified to perform, considering any limitations of your disabling condition. If the vocational skilful determines you can perform any task, the long-term disability insurance company cancels your inability benefits.
What to Do If I Receive Notice That My Long-Term Disability Benefits Stop Subsequently Ii Years?
Contact our long-term inability chaser immediately to discuss your options for appealing the determination. Yous must quickly human action because your time to appeal the conclusion is limited. Declining to file the entreatment earlier the borderline is i of the nigh common mistakes made by individuals whose long-term disability benefits are cut off afterwards 2 years.
LTD insurance companies utilise vocational reports to stop long-term disability payments after 2 years. These reports may not consider that you have a degenerative disease that will continue to worsen with time. Also, insurance companies may hire vocational experts, doctors, claims adjusters, and investigators who are more probable to side with the insurance company instead of the claimant.
Appeal a Denial of Benefits with Help from a Long-Term Disability Attorney
You can fight a long-term disability denial of benefits and win. However, you need help from a skilled, experienced long-term disability lawyer. Disability attorneys who work but with Social Security disability benefits may not have the experience and knowledge required to handle these claims. You demand an attorney with experience treatment ERISA-based long-term disability claims.
At the Police Office of Kevin J. McManus, we take substantial feel treatment LTD appeals field of study to ERISA laws and regulations. If you receive notice that your LTD benefits will stop after two years, contact our office to talk with an chaser about your options for appealing the decision. Call 816-203-0143 or consummate our online contact form for more information nearly long-term disability appeals.
Source: https://www.kevinmcmanuslaw.com/library/why-your-long-term-disability-was-denied-after-2-years.cfm
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