Ryan Findlay | December 14, 2024 | Long-Term Disability
What Does the Change of Definition Mean in Disability Cases?
When a worker is injured because of an accident or they develop an illness, they may be unable to work. Short-term disability provides temporary financial assistance while the person heals. However, what happens if they cannot return to work indefinitely?
Long-term disability (LTD) insurance provides financial benefits when someone cannot work for an extended period because of an illness or injury. You may be covered by LTD insurance through your employer or a private insurance policy you purchased. When you cannot work, long-term disability benefits are a lifeline. Losing those benefits because of a change of definition can be devastating.
What Is a Change of Definition in a Disability Case?
Change of definition refers to a clause in a long-term disability insurance policy. The clause usually impacts your case after the first two years of receiving benefits but could be sooner, depending on the terms of your insurance policy. The change of definition clause modifies the criteria for determining whether you are disabled or totally disabled.
To understand how a change of definition affects your disability case, you need to understand the terms “own occupation” period and “any occupation” period.
Receiving Long-Term Disability During the Own Occupation Period
When you apply for LTD benefits, the insurance company reviews your medical records and conducts an Own Occupation Test. The insurance adjuster investigates to determine whether you can perform the duties required to do your job without limitations.
The insurance company may require you to undergo an independent medical examination (IME) to confirm your doctor’s diagnosis. IMEs should be objective assessments performed by third parties. However, insurance companies often choose medical providers that are sympathetic to businesses.
You should qualify for LTD benefits if you cannot perform your job.
Receiving Long-Term Disability Benefits During the Any Occupation Period
A change in definition comes into play during the “any occupation” period. The insurance company contacts you to obtain additional information about your condition. They may ask for updated medical records and perform another independent medical examination.
The company may send you a questionnaire about your education, training, skills, and experience. The information covers all the jobs you have had in the past, not just your current job. The insurance company may perform a Transferable Skills Analysis to determine if any of your skills transfer to another job. Some insurance companies conduct surveillance to catch you doing activities that could be transitioned into a job.
The purpose of this Any Occupation Test is to determine if you can do any type of work. The change of definition modifies the definition of disabled to a more difficult standard to meet. For example, the definition may include whether you are qualified to perform one or more occupations or could become qualified with training, education, or experience. The goal is to find a job you can perform so the company can cut off your disability benefits.
What Should I Do When the Insurance Adjuster Calls About a Change of Definition?
It is essential to be honest with the adjuster. Do not exaggerate your injuries or restrictions. IMEs and other assessments will reveal you are lying, which hurts your disability case.
Instead, focus on explaining the problems your condition is causing in your everyday life. Explain what you cannot do because of your condition, such as bend over to pick things up or stand long enough to wash dishes. You may also explain to the adjuster that your spouse or another person now must do the majority of the housework when you did most of the chores before the injury.
Include how your injury impacts your social and extracurricular activities. For example, you cannot go on daily walks, volunteer at the local shelter, or play tennis. You were able to do these activities before the injury.
What Should I Do if I Receive Notice My LTD Benefits Are Denied Because of a Change of Definition?
If you receive a denial of long-term disability benefits, contact a lawyer immediately. You can appeal the decision, but you will need strong evidence that your injury meets the new change of definition for being disabled. An experienced LTD lawyer can review your case and explain your legal options.
Contact Our Long-Term Disability Law Firm in Ontario, Canada
If you need legal help with a personal injury case, contact the team at Findlay Personal Injury Lawyers to schedule a free consultation with an experienced Hamilton long-term disability lawyer. The sooner you have legal representation, the better for your case.
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