ERISA regulations allow for insurance companies to use specific standards to determine whether or not a person claiming a medical disability is able to work. When you initially file your claim and go through the process, they will be using the “own occupation” standard.
As the name implies, your insurer will attempt to see if you are able to do the work required by your current job or based on what you have in your history. The standards for different types of jobs are laid out by the Social Security Administration and defined in the Dictionary of Occupational Titles.
For example, if you’ve been a construction worker for the last decade, they will try to determine if you’re still able to lift heavy objects and engage in physical labor. Construction, which is considered “heavy” work, requires you to be able to frequently carry about objects of around 100 pounds. If some kind of injury or impairment is keeping you from doing this, then you would be eligible for disability.
ERISA Regulations Allow Insurers to Have Different Definitions
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While job standards are nationally defined and are always the same for everyone, each insurer is allowed to interpret how they will cover disability for someone who doesn’t meet the “own occupation” standard. Most medical disability policies will only cover you for an inability to do your specific job for a mere 24 months.
Two years isn’t bad if you’re suffering from some kind of impairment that will clear up with surgery, rehab, or both, but what if it’s truly long term? In that case, most insurers switch over to a much more stringent standard, the “any occupation” standard. This is why it is important to have an experienced long term disability attorney working on your claim. They will not only assist you in fighting for your own occupation benefits but they will be able to request documentation, medical reviews, and independent examinations in order to ready your claim for the any occupation period that follows.
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