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Dealing with the Long Term Disability “Occupation Transition”

When a worker gets injured on the job and needs to take significant time from work, then that is when Long Term Disability comes into the picture. The medical costs associated with treatment and recovery are covered while the worker is in the hospital. But it is that period of time spent recovering at home that concerns most workers. Disability insurance is designed to make sure that the worker has a source of income and gets the ongoing care he or she needs after an accident. But what happens if that worker cannot go back to his or her job to make a living?

The first 24 months of a Long Term Disability period is known to the insurance companies as an “own occupation” period. This means that the worker is unable to perform the majority if not all of the duties of his or her current occupation due to the injuries that have been sustained. For that 24 month period, the worker is legally entitled to all of the Long Term Disability benefits and treatment coverage that is afforded anyone else.

Once that 24 month period has expired, the worker’s case then transitions to a situation referred to as “any occupation.” This “occupation transition” is a critical moment for the worker, the employer and the insurance company. The insurance company will first determine if the worker can go back to his or her old job. If that is not possible, then the insurance company will try to determine if the patient can go back to work in any occupation through a series of assessments. If it is determined that the worker can return to some form of gainful employment, then the Long Term Disability benefits are stopped.

The problem that many workers face is that insurance companies will usually do anything they can to cease LTD benefits after that initial 24 month period. Workers are often left having to spend money they do not have defending the fact that they have a permanent injury that does not allow them to engage in any sort of employment. Workers do not need to accept the “any occupation” decision handed down by the insurance company. If a worker is legitimately disabled but the insurance company is trying to cease benefits, then the worker needs to fight back.

The worker needs to hire an experienced legal team to speak on his or her behalf and get the insurance company to change its “any occupation” decision. Once those LTD benefits are cut, the worker can start to experience immediate financial distress. That is why it is imperative that the worker hire a competent and experienced legal team immediately to address the problem.

For assistance with a personal injury or insurance claim, please email David at dhimelfarb@himprolaw.com. To be contacted immediately call 1-855-446-7765 for a free case evaluation.

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