The “Any Occupation Review” – What To Expect and How To Appeal

Have you received an “any occupation review” letter from your long-term disability insurance company? After you have been receiving long-term disability benefits for a certain number of months, usually 12 or 24 months, the definition of disability that you must meet will change.

The long-term disability insurance company’s letter will usually include a copy of the definition of disability contained in your long-term disability policy. A typical definition reads like this:

Total Disability or Totally Disabled means you are prevented from performing the Essential Duties of:

1) Your occupation or a reasonable alternative job offered to you by the employer during the elimination period and for the 24 months following the elimination period; and
2) After the 24 month period, Any Occupation.

The letter you received will probably say something similar to:
our LTD benefits became effective 12 months ago. To continue receiving benefits after 24 months, you must be disabled from any occupation. Please be advised that we have initiated an investigation to determine if you will qualify for benefits after the 24 months have elapsed. We will notify you regarding our determination.

What exactly does this mean to you?

You were granted long-term disability benefits because you could not work. You still cannot work. You have no idea what is meant by an “any occupation review!” Almost all employer provided long-term disability policies have a change in the definition of disability after you have been receiving disability benefits for a set period of time. Typical time frames are 12-months, 18-months and 24-months.

The change is that you must be disabled from performing any occupation instead of just your own occupation.

This is a major change. For example, if your occupation was a truck driver at a light-medium exertional level, your back injury may qualify you for long-term disability benefits initially. When the definition changes, the question is does your disability prevent you from doing ANY OCCUPATION – such as clerical work, inventory work, or other sedentary type occupations. The disability company understands that if you are entitled to benefits after this point in time, then chances are you will be receiving benefits for a long time. The disability company does not want this.

You can expect to receive a number of documentation requests and/or interviews in the months leading up to the disability payment of the “own occupation period.” Each request has one purpose – finding out what you can do so that they can get you off of claim by finding an occupation you can perform, and/or bombarding you with so many requests that you fail to turn one in and then your claim can be dismissed.

You will be faced with a completely new inquiry into your disability. Basically, you will have to prove your disability again, but probably to a more detailed level.

The specifics of your situation will be determined by the specific language of your long-term disability policy. If you are lucky, the definition of disability in your policy will give you some added protections, such as you must be able to earn a certain percentage of your pre-disability earnings, or that you must qualify for this occupation through education or knowledge..

You will probably need additional support of your continued disability, treatment, and inability to perform the tasks the disability company now claims you can do. It is important to maintain a good relationship with your doctor and continue to receive adequate treatment even after you are approved for disability benefits.

If you are faced with an “any occupation investigation,” or a denial because the insurance company found that you could perform in another occupation, you do not have to fight the insurance company alone. Below are a few steps you can take to help you fight the “any occupation” denial of your long-term disability insurance company:

• Read your policy to find out specifically what “any occupation” means under the terms of your policy;
• Request the entire claims file and see how the occupations the insurer says are appropriate were determined;
• Make sure the insurer’s decision took into account of your medically documented limitations when determining you could perform in its listed occupations;
• Submit updated medical records and make specific note to the insurance company of any new or additional limitations caused by your disability and/or medication side-effects; and
• Appeal the denial timely.

These are only suggestions of strategies that can improve your chances of getting your long-term disability benefits denial overturned and having your benefits reinstated or continued. They do not guarantee success.