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 carrier? 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 letter from the long-term disability insurance company will usually include a copy of the definition of disability contained in your long-term disability policy. A typical definition goes like this:

Totally Disabled or Totally Disabled means you are unable to perform the essential duties of:

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

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

What exactly does this mean to you?

He was awarded long-term disability benefits because he was unable to work. You still can’t work. You have no idea what an “any occupation review” means. Almost all employers that offer long-term disability policies have a change in the definition of disability after you have been receiving disability benefits for a certain period of time. Typical time frames are 12 months, 18 months, and 24 months.

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

This is a major change. For example, if his occupation was light- to medium-exertion truck driver, his back injury may initially qualify him for long-term disability benefits. When the definition changes, the question is whether your disability prevents you from doing ANY OCCUPATION, such as office work, inventory work, or other sedentary-type occupations. The disability company understands that if you are entitled to benefits after this time, you are likely to receive them for a long time. The disability company does not want this.

You can expect to receive a number of requests for documentation and/or interviews in the months leading up to the “self-employment period” disability payment. Every application has a purpose: to find out what you can do so they can get you off the claim by finding an occupation you can perform and/or bombard you with so many applications that you don’t turn in one and then your claim can be dismissed.

He will face a completely new investigation into his disability. Basically, you will have to prove your disability again, but probably at a more detailed level.

The details of your situation will be determined by the specific language of your long-term disability policy. If you’re lucky, the definition of disability in your policy will give you some additional protections, such as that 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 from your ongoing disability, treatment, and inability to perform the tasks that the disability company now claims you can do. It is important to maintain a good relationship with your doctor and continue to receive the proper treatment even after you are approved for disability benefits.

If you’re facing an “any occupation investigation” or a denial because the insurance company found you could work in another occupation, you don’t have to fight the insurance company alone. Here are some steps you can take to help fight your long-term disability insurance carrier’s “any occupation” denial:

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

These are just suggestions for strategies that may improve your chances of having your long-term disability benefit denial reversed and having your benefits reinstated or continued. They do not guarantee success.