Most, if not all, private disability plans have a changing definition of Disabled. Take a look at your plan. You can request a copy from your HR department.
You may not be surprised to find that the initial standard for being disabled is whether or not you can perform the essential duties of your job. In insurance company lingo, this is referred to as "Own Occ." It is the insured persons burden to prove that they are unable to perform at least one essential duty of their own occupation due to physical and/or mental impairments.
Where the surprise comes in is after a period of "Own Occ" disability, usually 24 months, the standard changes on you. Now it is the disabled person's burden to prove that they cannot perform at least one essential duty of any occupation. Yep, you guessed it, insurance companies call this "Any Occ."
Unlike Social Security Disability where the standard is whether or not the claimant can work at any job and earn about $1000 a month, private disability plans often define Any Occ as one for which you are qualified by education, training, or experience and that has an earning potential greater than some percent of what you were making before you became disabled. Beware of the changing definition. Your plan administrator is making plans right now to cut you off when the definition of disability changes from Own Occ to Any Occ. Although you will have a chance to appeal the termination of benefits you could be faced with several months or more with no disability benefits.
These cases are typically handled on a contingency fee basis which means the attorneys make no fee unless they win. It is critical to contact an attorney with experience handling private disability claims because you will have a limited time to appeal a denial of benefits and your appeal must set out ALL the evidence you will be relying upon to prove your case. If the Appeal is denied you can file suit in court however the judge will only hear the evidence presented in the appeal to determine whether or not you meet the Any Occ definition of disabled.
An attorney should contact all your doctors, send you for a Functional Capacity Evaluation (FCE), and have a Vocational Expert (VE) analyze your skills, education and experience relevant to the job market in preparation for your Appeal.
Also beware, your private disability plan requires that you apply for Social Security Disability. They will even present you with a vendor of their choosing to represent you so they can monitor your Social Security Claim and keep an eye on you. Contact your own attorney who handles Social Security Claims. You do not have to use your insurance company's vendor.
This blog post is not legal advice for your specific set of circumstances other than to strongly suggest that you hire a lawyer if you become disabled. An attorney can help if brought in immediately upon receiving your denial or being informed that you must apply for Social Security.
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Attorney Erik Rosskopf
An active member of the Florida and Georgia bar associations, he practices in Jacksonville Florida handling cases throughout North Florida and Georgia.