When a person is unable to work because of a severe illness or injury, long-term disability (LTD) insurance offers financial support. Many claimants are surprised to encounter a substantial hurdle known as the “change of definition” during their claim. This legal provision can significantly impact eligibility and is a primary reason for benefit denial or termination. Anyone dependent on LTD benefits must understand what “change of definition” means.
1. What Is a Change of Definition Clause?
Getting to know about the change of definition in a disability case is important for those with long-term disability insurance policies. This standard clause refers to a shift in how disability is defined. Typically, after a set period, usually 24 months, the criteria for being considered disabled change. This change can affect whether a claimant continues to qualify for benefits, depending on the policy’s specific terms and conditions.
2. The Own Occupation Period
At the outset of an LTD claim, disability is usually tied to the claimant’s ability to perform their occupation. During this period, benefits are payable if the claimant can demonstrate that their medical condition prevents them from carrying out the essential duties of their job when they become disabled. Lawyers must show they cannot fulfil the mental and physical demands of practising law, not that they cannot work in any job at all.
3. The Shift to the Any Occupation Standard
After the initial period, the definition of disability typically transitions to a much stricter standard, such as an occupational test. Under this new definition, claimants must demonstrate that they are unable to carry out the responsibilities of any occupation for which they are suitably qualified by education, training, or experience. The insurance company may request updated medical records, conduct new assessments, and even analyze the claimant’s transferable skills to determine if they could work in a different or less demanding field.
4. Legal and Practical Implications
This change in definition is not a mere technicality; it often marks a turning point in the claim. The burden of proof becomes significantly higher. While it may be relatively straightforward to show you cannot do your previous job, it is much harder to prove you cannot do any job, especially those that are less demanding or pay less. Insurers may argue that you no longer qualify for benefits if you can perform even a low-wage, part-time, or sedentary job.
5. How Insurers Apply the Change
Insurance companies typically notify claimants in writing when the definition change is approaching. They might ask for more medical exams or specifics about your training, employment experience, and abilities. Some insurers conduct surveillance or use vocational experts to identify jobs they believe you can do. The process can feel adversarial, and many claimants see their benefits terminated at this stage.
6. Responding to a Change of Definition
If you receive notice of a pending change of definition, it is vital to respond carefully. Provide honest, detailed information about your limitations and how your condition affects your daily life, not just your work duties. Supporting medical evidence is crucial. Legal advice may be necessary, as disputes over the definition change are a common source of litigation in LTD cases.
To Sum Up
The “change of definition” in long-term disability claims is a pivotal legal provision that can jeopardize your financial security. It changes the standard for receiving benefits from being unable to perform your job to being unable to work in any job suited to your background. This shift makes it more challenging to maintain long-term disability (LTD) benefits and often leads to disputes with insurers. Understanding this process, preparing thorough documentation, and seeking legal guidance can help protect your rights during this challenging transition.
