Collecting long term disability benefits while simultaneously working a full time job that affords you the luxury of collecting a paycheck might seem contradictory to the layperson. It might also seem fraudulent to some. The truth of the matter is that it is possible and it is totally legal.
Having the ability to collect both a paycheck and long term disability benefits concurrently will depend on the legal language in your disability policy. Total disability is defined in your disability insurance policy. This definition can vary from policy to policy. Three commonly used definitions include own-occupation, modified own-occupation and gainful occupation. Modified own-occupation and gainful occupation disability policies will usually disallow such a scenario. A disability policy with own-occupation language may not.
Own-occupation is the most flexible definition of total disability for an insured. If the insured is unable to perform the material and substantial duties of his or her occupation at the time of disability, the disability insurance company will pay the claim even if you are working in some other capacity or employment. However, this new or other occupation must not be identical or even similar to the occupation from which you are claiming disability. Moreover, some own-occupation policies are not "genuine" own-occupation policies and may prevent you from collecting a paycheck in addition to your long term disability benefits. Therefore, the disability policy should be read from cover to cover to prevent disability benefits from being terminated.
In essence, under the terms of an own-occupation disability policy, the inability to perform the material and substantial duties of your occupation will entitle you to long term disability benefits, notwithstanding your ability to work in some other occupation.
A classic example is when a physician surgeon is unable to perform the material and substantial duties of the surgical procedures and due to sickness or injury files for long term disability benefits. The claim is approved and the physician surgeon now resorts to physician office work only, such as patient consultations. In this new line of work, the physician might generate $500,000 during the first year, despite drawing $25,000 per month in long term disability benefits. There are countless examples of such scenarios that apply to many occupations.
The Law Firm of J.P. Gonzalez-Sirgo, P.A. represents individuals that have had their valid long term disability benefits denied, delayed or terminated irrespective of whether the policy was purchased individually or issued through an employer group policy. The firm is available to assist individuals with the initial application process, during the administrative appeals process, handling denials of claims or termination of benefits, litigation in state or federal court, and negotiating a one-time lump sum settlement or buy-out. Please contact our office to discuss your case in more detail.
You can reach Attorney J.P. Gonzalez-Sirgo by calling (786) 272-5841 or by emailing [email protected].
