Long-Term Disability Standard Stricter After 24 Months
Under most LTD [Long-Term Disability] policies, you are considered disabled if by reason of illness, injury, accident or infectious disease you are not able to perform the material duties of your regular job. The standard for granting benefits during the first 24 months of disability is commonly referred to as the “own occupation” provision and the standard thereafter is referred to as the “any occupation” provision.
After 24 months of LTD payments, benefits can continue only if you cannot perform any occupation for which you are suited or could become qualified by education, training or experience. In other words, the threshold you must satisfy in order to continue receiving benefits after the first 24 months becomes stricter in that you must prove you are not only incapable of performing your old job, but also all other jobs that your background would equip you to perform despite your disability.
Before denying benefits, administrators of ERISA plans are required to have enough evidence to allow them to make a reasonable decision; ERISA does not require a full-blown investigation, but it does demand a reasonable inquiry into a claimant’s medical condition and his vocational skills and potential. Employee Retirement Income Security Act of 1974, § 2 et seq., 29 U.S.C.A. § 1001 et seq. The insurance company’s failure to make a reasonable inquiry is grounds for an administrative appeal of the decision to terminate long term disability benefits, and for ultimately filing suit in federal court.
Alan Olson writes this web-log to provide helpful information regarding long-term disability cases. He practices long-term disability law throughout the United States from his offices in New Berlin, Wisconsin. Attorney Olson may be contacted at [email protected] with questions about the information posted here or for advice on specific disability benefit claims.