Change of Definition – What does this mean in a long-term disability claim?

Long-term disability (LTD) insurance is an insurance policy that can provide you with financial benefits if you are unable to work for an extended period due to an injury or an illness. This type of insurance provides people with a portion of their income while they are unable to work. 

To understand your LTD claim, it’s better to fully understand the Own Occupation Test and The Change of Definition (COD) term that decides whether you will continue to receive Long Term Disability benefits. 

Own Occupation Test:

What happens when you file for long-term disability? 

When you start your long-term disability file, you will be put through the Own Occupation Test. Typically the Own Occupation Test is something you will be under for approximately two years while receiving long-term disability benefits. During the two-year assessment, your insurance adjuster will investigate if you can do your job without limitations. As you approach the end of the two years (sometimes less depending on your insurance company), your insurance adjuster will reach out to you for more information on your injury or illness. This information gathered will help your insurance adjuster conclude if you qualify to continue to receive your LTD benefits.

At this time, you can assume that the Change of Definition term will be coming up. However, remember that just because the Own Occupation Test is usually two years, this is not always the case. You should read your policy of insurance to confirm when your test for disability benefits changes from the Own Occupation test to the Any Occupation test.

Change of Definition

The Change of Definition happens at the end of your two-year Own Occupation Test. When this takes place, it changes the status of your LTD Benefit so you may no longer be eligible to receive the LTD benefit.

During this time, your insurance company will look at your experience and training to see if you can do other jobs. Behind the scenes, your insurance provider has probably started to perform a computer-based analysis called the Transferable Skills Analysis. This Analysis will be implemented with your restrictions but is not entirely accurate, as there are other things to take into consideration when justifying if a person can work or not.

But what happens when your insurance adjuster has sent you a letter informing you that your Change of Definition term is coming to an end and you will soon be without the financial benefit, and you still can’t work the suggested jobs?

At this point you need to seek the advice of a lawyer. Findlay Personal Injury Lawyers advises that as soon as you get the hint that your Change of Definition is coming up OR when your insurance company starts requesting more information regarding if you qualify to receive the benefit, this is the time to speak with a personal injury lawyer.

What to do when your insurance adjuster calls you

Phone calls with your insurance adjustor are significant. Many times your medical records will not provide a complete picture as to how your injury or illness is impacting your life outside of your ability to work. Calls with your LTD claims adjuster provide you the opportunity to explain the problems you are currently experiencing with your day-to-day functioning, such as difficulty doing your housekeeping or engaging in your usual recreational activities. In addition to your medical records, the information you provide directly to your LTD claims adjuster should be taken into consideration by your insurance company when reaching a decision on your long-term disability benefit. 

When talking to your Insurance Company

  • Be honest
  • Go in-depth about your day to day functioning outside of work
  • What are you not doing? (Walking your dog, housework)
  • How has your disability affected your split of domestic duties at home? (Example: before becoming ill you did 80% of the housework, whereas now you are only able to do 20% of the housework and your partner has to do the remaining 80%)
  • Social pursuits (Can you still participate in volunteering, daily walks, church, going to the gym etc.) 

Can I appeal if my benefits are denied?

Yes, if your insurance company decides that you no longer qualify for LTD benefits you can appeal the decision directly to them, but unless your injury or illness has new medical findings, the decision will most likely remain the same and not be reversed. 

If you’ve been denied your LTD claim or have had your LTD suddenly canceled or terminated suddenly, contact Findlay Personal Injury Lawyers today for a free legal consultation.

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