Employer-sponsored long-term disability insurance (LTDI) policies provide income to employees who are unable to perform their job for an extended period of time, typically six months, due to injury or illness. Your entitlement to benefits depends on a number of factors, including your functional limitations, i.e. your medical condition’s impact on your ability to perform physical and mental tasks, particularly with respect to your job. When your health condition prevents you from working, examine your LTDI policy and consider the following:

a. How Does the Policy Define “Disability”?

Your LTDI insurance plan will define when you are considered “disabled” with respect to your ability to function in your job. Most policies, but not all, state that you are entitled to benefits for up to two years if you cannot perform the material duties of your own occupation. After this time period, you may be awarded benefits if you cannot perform the material duties of any occupation for which you are reasonably qualified. (See Own Occupation v. Any Occupation). Thus, your entitlement to benefits is dependent upon your restrictions and the length of time that you have been unable to work.

By way of example, if you cannot work in your job as mechanic because you cannot perform heavy lifting, then you may be disabled during your plan’s “own occupation” stage. After two years, however, you may no longer be disabled if there are other jobs that you could perform, such as sedentary jobs with no lifting requirements, and if you are qualified to perform those jobs.

b. Is Your Position Unique Compared to Similar Positions in the General Workforce?

Not only do disability plans typically limit the time period for which you can receive benefits when you cannot perform the duties of your job, they also define “own occupation” broadly. Some plans state that your “own occupation” does not refer to your specific job with your specific employer, but instead, that it refers to your position as it is understood in the normal workforce. Insurers often will use a vocational consultant to determine the physical demands of your position in the general labor market, not at your specific place of employment. Therefore, if the company you work for has more physical demands than normal, an insurer may still find that you are not disabled and that you are capable of performing the duties of your own job.

c. Are You Able to Work with an Accommodation?

Finally, for individuals to be considered “disabled,” some plans require that they be unable to perform their own or any occupation even with a reasonable accommodation. For instance, if you have a health condition that prevents you from standing for eight hours straight, a general requirement of your job, but you could perform the material duties of your job from a seated position, then, according to the plan, you may not be disabled. The insurer will not consider whether your employer is willing to grant you the accommodation. Instead, it will examine whether you would be able to perform the material duties of your job if your employer were to grant you the accommodation.

Each long term disability insurance claim is unique. Your claim depends on your medical conditions, your job duties, the evidence available and the provisions of your insurance policy. At Hawks Quindel, S.C., we want to help you navigate the process so that you can make the strongest possible case for your entitlement for benefits. If you would like to discuss your claim, please contact us for a free consultation.

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