Long term disability attorneys Rachel Alters and Gregory Dell explain how disability insurance claims are often reevaluated when the definition of disability changes from “own occupation” to “any occupation.” During the first phase—typically the first 24 months under many employer-sponsored policies governed by ERISA—a claimant qualifies for benefits if they cannot perform the material duties of their specific occupation as it exists in the national economy. After that period, the definition becomes stricter: the insurer may terminate benefits if it believes the claimant can perform any gainful job consistent with their education, training, and experience, often defined as work that pays around 60% of their pre-disability income.

The attorneys explain that claimants should begin preparing for this transition well before it happens—ideally around the 12-month mark—because insurers usually begin investigating around month 18. A key step is ensuring that physicians clearly document limitations that would prevent any full-time work, not just the claimant’s previous job. For example, doctors should note if the person cannot sit for long periods, focus consistently, or maintain a regular work schedule. Vocational experts may also be used to analyze whether realistic jobs exist that match the claimant’s limitations, salary requirements, and geographic labor market.

We also warn claimants to be careful with paperwork and communication during this review stage. Insurers often send detailed vocational questionnaires, conduct interviews, review social media, and even perform surveillance to find inconsistencies. Claimants should answer forms accurately but cautiously, since statements about activities like computer use could be used to argue they can work full time. Doctors should also be prepared for contact from insurance company physicians, and written responses are often safer than informal phone conversations. Overall, careful preparation, consistent medical documentation, and strategic handling of insurer requests can help prevent benefit termination when the definition of disability changes.