As you are probably aware, LTD policies contain a change in definition of disability that requires claimants to be disabled from working in ANY occupation for which they have training, education and experience. While this definition may seem similar as the definition of disability used by the Social Security Administration, it is slightly different and is managed in an entirely different way.
Between 18-24 months, ERISA LTD insurers will begin “an any occupation investigation” to document whether or not the claimant, based on his/her restrictions and limitations is capable of working in ANY GAINFUL OCCUPATION.
This investigation is indeed a garbage-in. garbage-out procedure if up to date restrictions and limitations are not used. Therefore, the investigation itself depends on the expertise of claims handlers performing it, if reliable results can be depended on. Unfortunately, claims handlers today are not trained in the process and if “any occupation investigations ARE done, they are done poorly.
Typically, the claims handler updates all medical R&Ls, then attempts an update phone call. Then, the claims are forwarded to some sort of rehabilitation unit, (I’m not convinced these exist anymore), and computer software is used to find alternative jobs the claimant can do that are gainful. The issue of GAINFUL has been one of my criticisms for years since the issue of GAINFUL is not addressed, or documented anyway. Each ERISA Plan should define what will be considered GAINFUL. Usually, the definition of gainful is located in the Glossary of the Plan; the most common definition being “60% of indexed pre-disability earnings.”
Again, it is unlikely that any claims handler will know how to determine how to INDEX pre-disability earnings. Basically, indexing uses inflation ratios to convert pre-disability earnings to equal purchasing power taking inflation into account. It’s quite a process, which is why it is also poorly done.
If alternative, gainful occupations are found, the claim can be denied. But, the question is always are the results of the any occupation investigation reliable. Most of the time they are not.
Most claimants just automatically take the insurers’ word that the result of an any occupation investigation are accurate. The truth is, however, that up to date restrictions and limitations are missing, and there is no proof the evaluator considered GAINFUL or INDEXING. INDEXING during the Trump years probably won’t make a difference, but in the Biden years when inflation was considerable, it could have been responsible for the denial of claims.
Depending on how much money a claimant can afford to spend, it is possible to have your own “any occupation investigation” done. It costs around $1,200 for a good one and not everyone can afford to spend money at their claims. It’s important to know, though, that when insurance companies conduct any occupation investigations, they are never done correctly, and your “goose may be cooked” before you even know it.
If your claim is approaching 18-24 months of paid benefits and you would like more information about coming on board as a DCS client, please feel free to contact me.
My website is located at: http//www.disabilityclaimssolutions.com and you can email me at: lindanee.dcs@gmail. com
Tel: 207-793-4593
I am looking forward to hearing from you.
