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Old 05-06-2013, 05:38 PM   #1
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LTD and the 24mnth own occupation clause

Apologize for typos in advance ---I am perplexed about my companies LTD policy. First I would like to say I ended up in this mess by getting hit by a drunk driver while working. I had several injuries . Had one surgery and expect another. I have cervical and lumbar radiculopathy and ortho doc suggests a 2 level cervical fusion. I suffered a head injury and have chronic migraine. A lot of head injury symptoms mimic and include anxiety and depression. Long story short - Employer was a total *** and pushed me onto LTD. I have been approved but asked to rtw with accommodations but until I rtw I wont know if I would be able to "keep" up in the same capacity prior to my accident.

I had to pull teeth to get actual LTD policy. It states 24mnth own occupation and then there is a section that limits a lot of spine\nervous\pain disorders. There is a section that states disability = unable to earn 80% of pre-disability earning in next 24mnth then says... after such period unable to ear 80% at any gainful occupation for which you are qualified in local economy. I am a white collar professional but just worked in my industry for 20yrs and do not have a college education just certifications which are industry specific and to go work for another industry like the one I am in it would not be local economy. Any ideas of this. The LTD provider who is working "closely" with Employer is very vague and wont answer direct questions - seems a lot of games are being played

 
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Old 05-07-2013, 12:30 AM   #2
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Re: LTD and the 24mnth own occupation clause

Generally speaking, the "24 month Any Occ" clause of most LTD policies works like this:
During the first 24 months you are disabled, they review your case to see if you are disabled from your own occupation. After 24 months, a complete review is done on your case and they review your medical info, and all info regarding any training or work experience you've had, and see if you are able to perform work in ANY occupation for which you could be gainfully employed. Gainfully employed means they don't expect you to work at Walmart if you were a VP of a bank. The income needs to be close to what you were making before. In your specific contract, it sounds like they would see if there is ANY occupation you could work with your training and experience where you would earn at least 80% of your pre-disability income. BUT keep in mind, they don't get you these jobs, they just see if these jobs exist in the economy. So, its a lot easier for them to list out jobs they say are available, but actually getting these jobs are up to you.
My advice is if you are on LTD to file for SSDI immediately, because most LTD claims DO end at that change in definition at 24 months. If SSDI is awarded by then (and it could easily take until then to get approved by SSDI) then you won't suddenly be without an income. Most LTD plans require claimants to file for SSDI anyway, as that is an offset to their policy. If/when approved for SSDI, your LTD benefit will be reduced to the difference between what your LTD pays and SSDI pays. You don't get full benefits from both. So, for example, if you earn $1000 a month from your LTD plan, and then you get approved for $800 a month from SSDI, your LTD will drop to $200 a month so your total amount between the two is still just $1000.
Hope this info helps you some. And Good Luck!!!!

Last edited by Whynowthis; 05-07-2013 at 12:33 AM.

 
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Old 05-07-2013, 09:28 AM   #3
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Re: LTD and the 24mnth own occupation clause

Thanks I think you nailed my suspicians. I am unclear though becauase I made a preety good wage in a white collar field without college just some certs that wont necessarily get me anything in my local economy and physically I am limited so even if I say got a project manager job etc could be physical req would not allow me to qualify. I have a chronic migraine syndrome as a result of my accident and doc doesnt know if\when it will end. The worst of the HA's are episodic but would require I miss work at times and I dont think any job especially one that is considered a "career" type position will tolerate that for long

 
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