What is the “Change of Definition” Date in a Disability Claim?

Some disabilities can last a very long time, despite our efforts to get better and get back to work. Unfortunately, some disabilities turn out to be permanent. People want to know if their long-term disability (LTD) benefits will be with them for as long as they need support. They are often surprised to hear from their insurance company that their benefits could be terminated after only two years because of something in the insurance contract called the “change of definition.”

I’d like to briefly explain what this is all about and ultimately leave you with the message that even if your insurance company tells you that your benefits will be stopping due to the “change of definition,” you don’t have to accept this. You can fight back.

What changes after two years?

Different LTD policies use different wordings, but they actually have a lot in common. Almost every policy I see requires the insurer to pay you benefits if you are “totally disabled” from work. In the overwhelming majority of policies, the insurer is required to keep paying you for as long as you remain totally disabled, even if that’s for 5, 10, or 20 years, right up to age 65.

So why is your insurer telling you that your benefits may stop after two years? What changes after two years? The definition of “total disability” changes.

How does the definition of “total disability” change after two years?

Under most policies, for the first two years the phrase “total disability” means that your disability prevents you from returning to your job. That’s why these first two years are often called the “own-occupation” period. It’s the period of time when being totally disabled means being disabled from your own occupation.

After two years, the definition of “total disability” changes – now, you will only qualify if your disability prevents you from returning to any “reasonably suitable” occupation. That’s why the period after the first two years is often referred to as the “any-occupation” period. It’s the period of time when being totally disabled means being disabled from any reasonably-suitable occupation.

What’s a reasonably suitable occupation?

As you may have noticed, the phrase “any-occupation period” isn’t strictly accurate. The question isn’t whether you are disabled from any occupation at all, it’s whether you’re disabled from any reasonable occupation – that is, any occupation that you are reasonably suited for by your education, training, and experience.

For example:

• Someone who has operated heavy machinery for his entire career may not be reasonably suited for a job in an office. He may not have the background or experience required to succeed in that kind of job.
• Someone who has been a manager for her entire career may not be reasonably suited to an entry-level position. That sort of job may not be appropriate for her given her background and experience.

Termination of benefits at the change of definition is not automatic

Too often, I speak with people who have come out of conversations with their insurance company believing that now that two years have almost passed, and the “change of definition” date is approaching, their benefits will have to stop. In most cases I see, this is simply wrong. In my experience, if you are disabled from your own occupation today, you are most likely also going to be disabled from any reasonable occupation tomorrow – unless and until your health improves.

Different jobs obviously have different demands: some are more physically strenuous than others; some require more sustained focus and concentration than others; some require more interpersonal interaction than others. But nearly all jobs share some key requirements:

• you must be able to show up for work reliably and on time on every workday
• you must be well-rested and physically comfortable enough to do your job
• you must be physically capable of maintaining required postures for extended periods of time
• you must remain calm and interact productively with colleagues
• you must be alert, careful, and focused to avoid making mistakes

If your disability prevents you from functioning well in a workplace environment, your insurer should not be terminating your benefits, whether or not two years have passed.

If you believe that your insurer may be planning to terminate your benefits at the “change of definition” date, I’d encourage you to contact a disability lawyer like me to discuss your options and how to be ready to respond if and when your benefits are terminated. We can discuss the medical evidence needed to prove that you meet the “any-occupation” test for disability so that your benefits can continue. If, despite the evidence, your insurance company nonetheless decides to terminate your benefits, we can help you fight back.