Mansell, Engel & Cole

A potential problem for long-term disability claimants

If you are disabled and collecting payments under a long-term disability policy, that's pretty much a done deal, right?

That is, there should be no challenge to your claim by an insurer once you have -- and continue to be -- medically verified as unable to perform your customary work owing to injury or illness.

Ah, were life so simple. A recent article on a common insurance company tactic employed to deny LTD benefits  notes that approved claimants must often be "wary and aware" of the potential for post-approval claim denial based on often controversial policy language.

What that article focuses on is the "own occupation" versus "any occupation" distinction that can arise in a policy.

Here's the bottom line. Some policies state that a claimant can continue to receive LTD benefits while unable to perform in a particular occupation. That means that, say, a dentist who is receiving a disability check can continue to do so as long as he or she cannot work as a dentist.

Conversely, an "any occupation" provision can deny that professional LTD benefits if he or she is able to work in virtually any field. The above-cited overview references "potential employability in all potential vocations."

It is hardly surprising to note that insurers will often try to render that "any occupation" verbiage applicable to a claimant's case, even when a claim has been initially approved. They do so by attempting to "transition" an own-occupation policy to an any-occupation policy some time after benefits are already being received.

Many of our readers will likely point to that as being patently unfair -- even underhanded and illegal.

Attempted claimant denial based on any number of factors is a common reality in the insurance industry. Consumers rightly seeking to fight back can contact a proven policyholders' insurance law attorney for prompt and aggressive advocacy.

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