most policies have a two-part definition of disability. during the first 24 months, the “own occupation” standard applies: you are considered disabled if you are unable to perform the essential duties of your specific job. after 24 months, the “any occupation” standard takes over, and you must prove you are unable to perform any job for which you are reasonably suited by education, training or experience.
under either standard, the insurer may argue you can work a different, less demanding job, even if your medical condition has not changed or has worsened. the strength and shape of your response will depend on which standard applies to your claim, but the underlying principle is the same: a termination letter is the insurer’s opening position, not the final word.
what to do right now
if you’ve received a termination notice, don’t panic. acting impulsively could harm your chances of successfully appealing the termination.
termination letters are written to sound intimidating and definitive. many benefit cut-offs, at both the own-occupation and any-occupation stages, are successfully challenged and overturned with the right legal strategy.
do not rush back to work. your first instinct might be to find work immediately to cover your expenses. however, returning to work prematurely can:
- worsen your health condition, leading to a significant setback
- be used by the insurer as evidence that you are, in fact, capable of working
- seriously undermine your legal position and ability to fight the termination
gather your documentation
it’s important to preserve all your documentation and gather everything related to your claim, such as:
- the termination letter and the envelope it came in
- your complete insurance policy document
- all medical records, test results and reports from your doctors
- any emails, letters, or notes from conversations with the insurance company