5 Common Terms You Must Know Before You Apply for LTD

If you’ve ever applied for long-term disability (LTD) benefits, you know it can be a difficult process. Not knowing the key terms they use can put you at a serious disadvantage. Below are the 5 most confusing – but important – LTD terms you need to know if you want to be approved for and stay on a long-term disability claim.

1) “Total Disability”

What does “total disability” mean?

“Total disability” is a threshold used to determine if you qualify for LTD. It means that an individual is suffering from an illness or injury which prevents them from performing the essential duties of their occupation. It is a term made-up by insurance companies to mislead people and deter them from applying for LTD benefits.

Only you and your doctor can decide if you are totally disabled. If your LTD claim is denied because your adjuster said you aren’t totally disabled, don’t take that as the final word on the matter. You can speak to a long-term disability lawyer who will help you get the compensation you’re owed.

2) Own Occupation vs. Any Occupation

How do I understand “own occupation versus any occupation”?

The definition of ‘totally disability’ for the first two years is whether you can perform the essential tasks of your own occupation. But the definition changes at the two-year mark. After two years, the definition of ‘total disability’ now becomes: Can you perform the essential tasks of any occupation?

But ‘any occupation’ doesn’t really mean any job at all. Any occupation only applies to jobs for which you have suitable education, skills, or experience. It also only applies to jobs that would provide you with at least 60% of your previous income.

At the two-year mark, insurance companies may make claimants attend a skills assessment. They want to build a case that you no longer qualify for LTD. They are nervous that if you are still totally disabled, they will have to continue to pay you benefits.

3) Pre-existing Condition

What is a pre-existing condition?

A pre-existing condition is a condition that you previously received treatment for that is in some way related to the disability that is preventing you from working. It does not refer to any condition you ever had. It is an exclusion clause to allow the insurer to avoid paying your benefits.

Every insurance policy is worded differently, so it’s important to check your specific policy. If the language in your policy doesn’t match your situation, the insurer can’t deny your benefits. Insurance companies often incorrectly deny claims due to pre-existing conditions. An experienced long-term disability lawyer can often find a way around the denial.

LEARN MORE
• Obtaining a Copy of Your LTD Policy FAQ

4) Return to Work

Can my insurance company force me to return to work?

If you’re receiving long-term disability benefits, eventually your insurance company may pressure you to start a return-to-work program. If you’re not ready to return to work, but you’re getting pressure to do so, advise your adjuster in writing that you are not ready. Tell them you’d like to go back when you’re ready, but your doctor has not cleared you for work. You can provide a letter from your doctor confirming this.

It is important to only try to return to work when you feel well enough, and optimistic about your chances for success. If your return-to-work attempt fails, it can be difficult to get back on claim, despite the existence of a recurrence clause in most policies.

EXPLORE FAQs
• Return to Work and Long-term Disability FAQ
• Dealing with Difficult Adjusters and Long-term Disability FAQ

5) Recurrence Clause

How does a recurrence clause affect my LTD?

A recurrence clause means that if you do try to return to work, but are unsuccessful, that you can go back on your existing claim. You don’t have to start a new claim for benefits. In theory, it removes the waiting period that exists for new claimants.

However, recurrence clauses don’t always work. Insurance companies will often point to a claimant’s attempt to return to work and say that it’s proof that they are no longer totally disabled. They will try to stop individuals from getting back on claim.

This is why it is crucial not to try to return to work until you are confident of your ability to succeed. Even though there is a recurrence clause in your policy, they are rarely applied the way they are intended, and it could be hard to get your benefits back if your return-to-work attempt fails.

Was your LTD Claim Denied?

If your claim was denied, don’t give up. Insurance companies deny legitimate claims all the time. If you have the support of your doctor, you should be getting disability benefits. Don’t waste time with your insurance company’s appeals process. It will only run out the clock on your time limit to file a claim for full compensation.

The experienced long-term disability lawyers at Samfiru Tumarkin LLP possess the knowledge and insight necessary to get you the money you are owed. Contact the disability lawyers at Samfiru Tumarkin LLP today for a FREE CONSULTATION.

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