Frequently Asked Questions: Disability Benefits

Disability Benefits

Frequently Asked Questions

When illness or injury prevents you from working, disability benefits can provide important financial support. But applying for benefits — or dealing with a claim that has been denied or terminated — can be confusing and stressful. These frequently asked questions provide information about disability claims, medical evidence, insurance decisions and the options that may be available when disability benefits are denied or discontinued, including when it may be helpful to speak with a Weir Bowen lawyer.

1. How do I know if I qualify for long-term disability benefits?

The starting point is your disability insurance policy.

Most policies define what they consider a disability and set out the conditions you must meet to receive benefits. Your medical condition is important, but the diagnosis alone usually isn't the whole question.

The insurer will also look at how your condition affects your ability to function and perform the duties required by your work.

Policies can differ significantly, so understanding the particular definition contained in yours is important.

2. What does “disabled” actually mean under my insurance policy?

It may mean something different than you expect.

Many long-term disability policies initially ask whether your medical condition prevents you from performing the essential duties of your own occupation. Others — or the same policy at a later point — ask whether you are capable of performing another occupation for which you are reasonably suited by your education, training or experience.

Those definitions matter because they determine the test you must meet to continue receiving benefits.

3. What’s the difference between “own occupation” and “any occupation”?

Under an “own occupation” definition, the question is generally whether your medical condition prevents you from performing the essential duties of the job you were doing when you became disabled.

Under an “any occupation” definition, the test becomes broader: are you capable of performing another occupation for which you are reasonably suited by your education, training or experience?

Many policies change from the first definition to the second after a specified period. That change can have a significant effect on a person's benefits.

4. Why did my insurer stop my benefits even though I’m still unable to work?

Sometimes the issue isn't that your medical condition has improved. The definition of disability in your policy may have changed.

For example, a person may qualify for benefits because they cannot perform their own occupation. After a period of time — often around two years, depending on the policy — the insurer may begin assessing whether that person can perform any suitable occupation instead.

That change can result in benefits being terminated even though the person's health hasn't significantly changed.

If your benefits have been stopped, it is important to understand the reason the insurer has given and the particular wording of your policy.

5. Can I qualify for disability benefits for depression, anxiety, PTSD or another mental health condition?

Potentially, yes.

A psychological condition can be every bit as disabling as a physical injury. Depression, anxiety disorders and PTSD can affect concentration, memory, reliability, interaction with other people, the ability to cope with stress and the ability to maintain a regular work schedule.

One of the challenges with these claims is that the condition may not produce the kind of objective medical evidence associated with a broken bone or another visible physical injury.

Detailed medical documentation showing how the condition affects your ability to function can therefore be particularly important.

6. What if my disability can’t be seen on an X-ray or medical test?

Many legitimate disabilities are not easily visible or measurable.

Chronic pain, fibromyalgia and many psychological conditions can significantly affect someone's ability to function even though an X-ray, scan or blood test doesn't provide a simple explanation for what they are experiencing.

In these cases, medical documentation becomes especially important. The evidence should describe not only the diagnosis and symptoms, but how those symptoms affect your ability to concentrate, move, maintain a schedule, deal with stress and perform the other activities your work requires.

7. What should I do if my disability claim has been denied?

A denial from the insurance company does not necessarily mean the matter is over.

The first step is understanding why the claim was denied. The insurer may dispute whether you meet the policy's definition of disability, question the medical evidence or rely on an assessment performed by one of its own medical examiners.

Because disability policies and their deadlines can be complicated, getting legal advice early can help you understand what the insurer is relying on, what evidence may be missing and what options remain available to you.

A note about this information: These FAQ's provide general information only and are not legal advice. Every situation is different, and the law may apply differently depending on the circumstances. Legal deadlines apply, so you should not rely on this information to determine a limitation period or other deadline. If you have questions about your particular situation, we encourage you to reach out to us.