Met life has changed the definition of disability - for the first 12 months its " you cant perform your regular job with company name because of sickness or injury " . after 12 months its now " you cannot perform the important duties of any other gainful occupation that you are reasonably fit by your education , training or experience . " which to me is basically anything . . so are they saying that as long as i can do some position some where i am not covered after 12 months ? or does this mean a position that is of at least the ability of my current education and training level . like if i am in my current job and can earn 50s based on my education / experience / training . if i am now only qualified to do a 10s position - how is that a reasonable fit based on my experience / educ / training ?
Jennifer J. AllenEmployment / Labor AttorneyNew Berlin, WI ·
This is a commonly asked question regarding the change in definition of disability in a long-term disability plan. The Plan initially covers a period of time during which you cannot perform your own occupation (the "own occ" provision), then changes to pay benefits is you are disabled from any occupation for which you are reasonably qualified given your age, education, and experience (the "any occ" provision). There is also usually a threshold earnings level meaning that if you cannot earn a certain percentage of your previous earnings (usually 60%) performing other work, your benefits will continue.
If your benefits are terminated by the insurance carrier under the "any occ" provision, you should speak with an experienced ERISA attorney to discuss appealing the decision. You have a limited time to file an appeal (180 days from the date of the termination of benefits).
Keep in mind as well that a lot of these plans require that you also apply for Social Security Disability benefits and pursue those benefits through a hearing before an Administrative Law Judge, if necessary, to preserve your eligibility for long-term disability benefits. If you have not already applied, you may be able to find an attorney who can assist you with both claims.
Jeremy Lyle BordelonSocial Security LawyersChattanooga, TN ·
See my answer to your other question. It sounds like the first thought I had was the right one - your policy changes the definition of disability from "own occupation" to "any occupation" after a while.
You have a good question about experience/ education/ training/ past earnings. Whether they say so or not, these policies are supposed to protect a certain amount of income. If the policy pays 60% of your prior earnings, they shouldn't expect you to return to a type of work that doesn't earn anywhere near that much. I will say, though, that the Courts don't always go along with my theories on this. If you'd like to read more about this issue, check out my Legal Guide on the subject:
http://www.attorneyqna.com/legal-guides/ugc/what-does-...
For more than that, I really would advise you to hire an ERISA attorney. Many of us work on a contingency fee - i.e., if your claim is denied, and you need our help, we don't charge up front. We charge a percentage of what we get you from the insurance company.
Again, good luck.
