Mason Waring: Hello, my name
is Mason Waring. I am an attorney and partner at Chisholm Chisholm & Kilpatrick.
I am joined here today, by my colleague, Attorney Leah Small.
We devote much of a practice to handling long-term disability insurance claims,
court litigation, and appeals. Yes, and we help disabled workers who received long-term disability
insurance from their employer or purchased policies directly from the insurance company.
Mason: Today, we are going to be talking about any-occupation insurance claims.
We are going to discuss what it means to meet the definition of any-occupation disability,
and variations of any-occupation definition based on earnings or occupation qualifications.
So, if you file for long-term disability insurance, you must meet your policies' definition
of disability, in order to receive benefits. Typically, there are two kinds of definitions
of disability that a claimant will be required to meet. One is own-occupation disability, and the
other is any-occupation disability. Which one you will need to meet depends on your specific policy,
and often you might have to transition from one definition to the other. So often, it is for the
first twelve, twenty-four, forty-eight months; it is own-occupation definition disability. And
thereafter it transitions to any-occupation. Leah Small: Generally speaking, It is known
after that first period as you mentioned, twelve, twenty-four, forty-eight months. It is no longer
enough if you just cannot do the job you were doing at the time you become disabled. At that
point, in order to continue to receive benefits, you have to demonstrate that you are unable to do
the material duties of any occupation. And as we will talk about a little later on --what exactly
that means-- can vary from policy to policy. But it is important when you are filing that claim
--if your policy does have that transition to any-occupation-- when [inaudible] your claim,
think about not only how your medical condition keeps you from doing your own job, but start
thinking early on; how does it keep me from doing any occupation. So you can build that foundation
at the initial start of your claim. And so when you face that transition, later on,
it might hopefully, although, a little easier for you. And it is important to note that
although this is how many policies operate, not every policy is structured this way.
Leah: Some policies only require claimants to meet that own-occupation definition the whole time.
Others might require you to meet the AF[?] patient definition from the outset of your claim.
So it is really important to read your policy to make sure you understand exactly what
definition you need to meet and when. Mason: And so there are different kinds of
any-occupation definitions of disability in a policies. Le, can you go into more detail
about some different variations? Leah: So some policies have just
very broad, vague, any-occupation definitions. And it might just say
the claimant must be unable to perform the duties of any occupation. And that is it. This type of
policy can be problematic because it is often challenging to satisfy such a broad definition.
For example, the insurance company might say that if you can do any job --even a part-time
job that is not within your prior field-- you are no longer entitled to benefits.
And in circumstances where your policy has that kind of definition, it can be really useful
to bring a lawyer in, if you are worried that the insurance company might terminate you.
When it switches to this definition, or if they do terminate you because we can help you gather
the specific evidence you need including medical evidence, and vocational evidence to prove
that you cannot work in any occupation. And if necessary, we can also help fight the insurance
company, and how they are interpreting that broad definition because potentially it may not be
supported by the policy language that is really as broad as the insurance company is saying.
And a lawyer can help you make those arguments. Mason:
As a general matter, the any-occupation definition of disability can be harder to meet
than the own-occupation. Is that right, Leah? Leah: Correct. Generally, yes. Depending on what
your occupation was, but yes. Mason: Right. Because either own-occupation
is whether you can do the material duties of the occupation you were doing before. That is
generally typically how it is. And we have a video talking more about own-occupation
definitions of disability. With any occ[?], often, it is whether you can do any job,.and
leaves them to talk about some qualifiers there. But it really speaks more to an inability.
A broader inability to work, and often you need to be more disables to meet that any-occupation
definition of disability. So let us talk more about that. Some policies contain that
narrower and narrower any-occupation definition of disability. Leah, what are those look like?
Leah: So some policies will specify that you must be disabled from any gainful occupation.
And typically, under any gainful occupation definitions of disability, the insurance company
will look at whether you are able to perform an occupation that earns you a certain percentage
of what you are earning prior to your disability. Usually, it is sixty to eighty percent of your
pre-disability earnings. So for example, an any gainful definition of disability might say,
you must be disabled from a job, that earns you at least sixty percent of your pre-disability
earnings. And if you earned a hundred thousand dollars per year prior to your disability,
you only need to demonstrate that you are unable to do a job, that would earn you,
at least sixty thousand dollars per year. If you can do a job that earns you less than that, you
may still be entitled to benefits under a gainful any-occupation definition of disability. And this
becomes significant, especially for people who were high-earners prior to their disability
because the gainful threshold is, therefore, higher and those occupations are generally more
demanding. And so because of this, the insurance company may have a harder time finding jobs that
you can perform, given your medical condition. Leah: Now, other policies might not have a gainful
component. But they may say, you must be disabled from occupations that you are qualified for,
based on your training, education, experience, or sometimes even age.
This can also significantly impact your claim because, for example,
you may only have a high school education, and perform manual labor for your entire career.
So you may still be entitled to benefits, even if you could go perform office work physically,
given your medical condition because you are not qualified to go work in an office given
your training, education, and experience. Mason: Thanks, Leah. And it is important to
note that even if you have a definition that takes your earnings or other qualifications
into account, it may still be difficult to prove your claim. Insurance companies often
use vocational experts or outside vendors to look at the work, and claim history,
and determined whether you are able to work in other certain jobs. And so it is important to put
together a strong case for your disability to prove your entitlement to benefits. And
one thing that we do see insurance companies do is to take a real narrow view of your health
situation. And so if you are suffering from three different conditions which have impairing effects
--just something basic, let us say, you have a sleep disorder, and you have chronic pain.--
so, I guess we will go to the most simple. They may look at them individually. And
one or the other may not be enough to disable you from working in any occupation, but together,
they make collectively render you disabled. And so one tactic that is used is, they will look at
everything in a silo, instead of looking at you as a whole person. And it is really important to do
that. And so both medically and vocationally, you really want to make sure that you are being taken
into account as a whole person. Mason: And that is something that we spend a
lot of time doing for clients. That is whether it is an initial claim --people come to us for help
on the initial claim-- or for an administrative appeal, if they already received a denial.
We take the time to get to know you. What your work life was like? How your health is
impacting your personal life? What the realistic prospects are, for improvement in your health? And
really tell your story. It is a hard thing to do. And particularly, if you have been in
the trenches, working and pushing through an illness, and you are being[?] taking
care of your health. Then you have financial stresses. It is hard to have a clear vision
about your picture. And that is something important that we bring to the table here,
in addition to all the legal expertise that we have. So if you need help with a claim
and appeal, do not hesitate to reach out for free consultation. We would be glad to talk to you.
Leah, can you sum things up for our viewers? Leah: Yes. So step one; read your long-term
disability policy so that you are aware of how your particular insurance company, and policy,
defines disability under that any-occupation definition. It is really important that you
understand that, so that you can determine what kind of evidence you need to submit,
to support your continued disability when you transition to that definition. As we discussed,
insurance companies might have very broad any-occupation definitions of disability.
But, it might also have a more narrower definition that takes into account your qualifications, or
where you are earning prior to disability. If you are facing that transition to the any-occupation
definition of disability, it can be really useful to hire an attorney like CCK at that point,
because this can be a difficult and confusing time to navigate. And as you enter, we have experience
helping individuals navigate that process. Whether it is getting vocational evidence from
an expert, who can analyze, what training, education experience the claimant has,
what they were doing prior to their disability, and how that compares to their medical condition,
and really put together post-evaluation, of whether they meet that any-occupation definition
of disability, given all of that. And, I said, it cost nothing to reach out and contact us.
If you are facing this transition. You are having difficulty demonstrating
that you are entitled to continued benefits under the any-occupation definition.
And you can give us a call, and we are happy to talk with you and see if we are able to assist.
Mason: Yes, our phone number is 401-331-6300, and our web address is www.cck-law.com. Thank
you all for tuning in here today. And Leah, thank you for that great information. Have a great day,
everybody. [background
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