Denial of Disability Benefits: Change of Definition

Disability Law

If you have been approved for disability benefits through your disability insurance company, you need to be aware of the “Change of Definition” (“COD”) date because it could mean that you may soon be cut off your disability benefits.

What is the COD date?

In your insurance policy or contract, there is often two distinct definitions of “total disability”. The first being that you are totally disabled from performing the essential duties of your “own occupation”, and the second being that you are totally disabled from performing the essential duties of “any occupation” for which you have the education, training and skill. The COD date is the date upon which the definition of “total disability” changes from “own occupation” to “any occupation”.

While each insurance policy differs on when the COD date occurs, you generally have two years under the “own occupation” definition before it changes to “any occupation”.

What happens at the COD date?

As you approach the COD date, the insurance company will often contact you to advise you that this date is approaching and request further medical evidence to support continuation of your disability benefits past the COD date.

It is important to note that the COD date provides the insurance company another opportunity to deny your disability benefits because the onus is on you to prove that you are not only totally disabled from your own occupation but you are also totally disabled from any occupation.

What evidence needs to be provided at the COD date?

Prior to the COD date, you will want to ensure that you have provided the insurance company with medical evidence that now supports you being totally disabled from working in any occupation. The previous medical evidence you provided that resulted in you initially being approved for disability benefits, may no longer be sufficient. The evidence required to support benefits past the COD date may include updated clinical records and notes from your physician, test results, etc. that show your functional limitations and restrictions as it relates to your ability to work any occupation that you have the education, training and skill.

If you are approaching the COD date and you have questions about ensuring your entitlement to disability benefits or you have been cut off disability benefits at the COD date, contact our disability lawyers at Zacharias.

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