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Defining ‘disabled’ for a long term disability insurance provider

On Behalf of | Jun 15, 2023 | Long Term Disability Claim Denial

Whether you think of yourself as disabled due to an illness, injury or congenital condition depends on your personal outlook. But defining “disability” becomes important when it comes to making a claim for long term disability insurance benefits or appealing a denied claim. To prevail, you must prove that you are disabled according to the insurer’s definition of that term.

Both employer-provided plans and private LTD insurance policies define short-term and long-term disabilities differently. Most insurance companies will not pay out on an LTD claim unless there is sufficient evidence the claimant’s condition is so severe that they cannot work at their own job for a specified period of time or any job thereafter.

Most LTD insurance policies have a 24 month own occupation definition of disabled and then the definition changes to the more onerous any occupation definition.  LTD benefits most often last up to age 65 or the Normal Social Security Retirement Age, depending on the particular policy’s terms, and presuming the claimant does not get medical clearance to return to work before the benefits period expires.

Meeting the challenge of appealing a denied claim

Making a strong appeal after a denied LTD claim is a complex process. Insurance companies work hard and spend considerable resources to avoid paying disability claims. Fortunately, you can work with an attorney for help gathering evidence, preparing your appeal, negotiating a reasonable settlement and going to trial, if necessary.