The concept of “alternate employment” becomes relevant in the LTD insurance context once the insured makes the transition, based on his or her policy, from being unable to engage in his or her “own occupation” to whether they are unable to perform the duties of “any occupation”. You can read more about the meaning of “own occupation” and “any occupation” here. At this juncture, the question becomes whether the insured is unable to perform the duties of any occupation due to his or her medical condition. Once the insurer has determined that you can perform the duties of “any occupation”, it will proceed to cut off your LTD benefits, since you are now deemed able to work. Once this happens, many are left wondering if their LTD insurer can cut off their benefits before they have found a job. Unfortunately, the answer may be yes.
If you have exhausted your appeal avenues, being the internal appeals through your insurance and through the courts, and it has been determined that you are able to perform the duties of “any occupation”, your insurer can stop your benefits, regardless of whether or not you have a job. This is because your LTD benefits are based on your ability to work, rather than the availability of work. This means that you will have to find “alternate employment”, or apply for other benefits intended to cover the unemployment period, rather than disability.
Insurers will often argue that you can perform the duties of an alternative job in order to stop your benefits. Therefore, in order to protect your entitlements, it is very important that you consult a lawyer with LTD expertise if your insurer is claiming that you are now able to work. While you cannot request that your LTD insurer continue to pay benefits while you find employment, you can argue that the work your insurer claims you are able to do is in fact not suitable.
You can dispute your insurers assessment regarding your ability to work on the basis that the jobs your insurance provider alleges you can do are not suitable or comparable to your old job. The proposed job may not be suitable for various reasons, including where it is only available in other communities, if the salary is substantially lower, or it requires a completely different set of skills than the one you had. For example, the insurer could not stop LTD benefits on the basis that a doctor can now work as a cashier. The question is not only whether you have the ability to perform the duties of the job, but also whether it is reasonably comparable to your old job, based on education, training and experience. Therefore, even if you can perform the duties of another job, you may still be deemed unable to work due to a medical condition, if such a job is not comparable to your old job on the basis outlined above. In such cases, you would continue to be eligible for your LTD benefits.
