untangling the complex web of long-term disability (ltd) insurance is challenging and even more so when you are ill. for many, the promise of financial support during impairment is a lifeline. the reality is that many ltd claims are denied or discontinued prematurely, leaving claimants in financial peril without any source of income. to understand the rationale behind these decisions, here are the top 10 most common reasons insurers deny or discontinue ltd benefits, and how we have assisted our clients to overcome them.
the corollary is that insurers should not penalize a person suffering from depression, for example. who has insufficient income to pay for the recommended psychotherapy — especially if they have exhausted their group benefits, or worse, have none.
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insurance companies employ surveillance tactics. this can include monitoring your social media accounts to compare posts of your recent vacation trekking in machu picchu against what you have told the insurer about your restrictions. insurers will even hire private investigators to follow you. if an insurer discovers that you have contradicted your reported limitations, the odds are that your benefits will stop. be mindful of your online presence and avoid activities that could be misinterpreted.
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perhaps the most common reason for discontinuance is when the eligibility for benefits changes (usually at the two-year mark) from whether you can work in your “own occupation” before two years versus “any occupation” — a much tougher test — after two years. a person may be considered disabled under one definition but not the other. do not be fooled into thinking “any occupation” includes flipping burgers, which lands you a fraction of your previous earnings at the bottom of the corporate ladder. the analysis involves an earnings threshold for the new job — often between 60 and 70 per cent of prior income — and mandates comparable status to your previous role. more often than not, a change in definition denial is overcome with a legal claim along with your doctor’s support.
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