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LTD - 2 Year any Occupation Clause

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    LTD - 2 Year any Occupation Clause

    I am coming up on a review by insurance carrier of my disability at the two year mark. The company had a traditional LTD policy which covered being disabled from my own occupation for two years. After two years, it switches to any occupation, supposedly, reasonable given education, skills, prior jobs.

    I am one of those people with the invisible symptoms: fatigue, pain, dizziness, focus/memory issues. I have had cognitive testing, and all three times, within a point of overall IQ. I had some deficiencies, but each time, different, which neuropsych attributed to fatigue.

    The lawyer who won my appeal after initial denial, told me any occupation can be really tough to win, especially for someone like me, who appears normal. My real problem is being able to sustain effort, even with sedentary employment.

    Has anyone won their group LTD for any occupation, without having strong physical/mental symptoms? Or if you were denied, were you able to win on appeal? If so, what was strategy? I have neuro and neuropsych support, but know based on original denial, won't be enough. Even with a less demanding job, I can't work 40 hours a week. Just not sure I should pay lawyer if hopeless cause, since they get paid regardless of outcome (unlike social security, which for me, is still awaiting hearing).

    Thanks for any insights, good or bad.
    Kathy
    DX 01/06, currently on Tysabri

    #2
    Kathy to be successful in a LTD application you need to have medical support. Even your lawyer has to have a medical expert to support your claim.

    This is my recommendation.

    Get your policy and look up the wording under definition of disability. Book an appointment with your Doctor. Take in the wording of the definition of eligibility for LTD.

    Discuss your limitations with your Doctor and ask him/her if they agree that you are totally disabled under the wording of the policy. If they are in agreement Ask your Dr. To write a letter supporting your LTD and quote the policy. For example.

    "I have reviewed The disability definition and at this time Kathy is totally disabled and is unable to perform the essential duties of any occupation for which she is reasonably qualified by training, education or experience.

    MS is a progressive disease and until such time that a cure is found that can reverse current damage Kathy remains totally disabled."

    You could also ask your neuro for a similar letter. Then you have two medical opinions supporting your claim. The wording of the letter is key. Many Doctors don't like to be told how to write a medical report but will understand when you explain why the wording is so important.

    When an adjuster reviews the medical records they are looking for the wording that supports their definition. Once they have medical support using their own definition they are hard pressed to deny benefits. They would have to obtain their own medical opinion stating that you are able to work at something else.

    I hope this helps. Good luck with this.

    AMJ


    Sent from my iPad

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      #3
      Thanks amj. My neuro did a good job on the form, stating my disability prevents me from working full time, as I cannot sustain the effort on a consistent basis. He indicated that since progressive disease, he did not anticipate that I could ever return to work at any level. The neuropsych as well indicated the same. It still did not prevent them denying it initially. We won on appeal for the "own occupation", partly due to a screw up on timelines on their part. They were late per contract terms in dealing with appeal.

      Worst of all, neuro retired at end of last year, so seeing new one. I will take your advice and bring definition with me. That is definitely a great suggestion. We talked about it at first appt, but think as you said, wording is*crucial.

      Thanks again.
      Kathy
      DX 01/06, currently on Tysabri

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