Month 24 Is When Insurers Terminate Benefits En Masse. Here Is Why. and What You Can Do
Two Years In — and the Rules Change
For the first 24 months of most employer-sponsored LTD policies, you qualify for benefits if you cannot perform the material duties of your own occupation — the specific job you held when you became disabled. A surgeon does not have to prove she cannot be a cashier. A software architect does not have to prove he cannot answer a phone. But at the 24-month mark, the standard changes. Now you must prove you cannot perform any gainful occupation for which you are reasonably suited by education, training, or experience. Insurers use this transition to terminate tens of thousands of claims every year — many of them legitimately ongoing. Understanding the shift, and building your medical and vocational record before it arrives, is the most effective defense available.
What you need to know
Plain-English answers to the questions that come up most often on these cases.
The Own-Occ to Any-Occ Shift
The policy language controls the exact timing — some plans use 24 months from the date of disability, others from the date benefits begin. The shift triggers a new round of insurer review and often a new round of independent medical examinations.
Read moreVocational Evidence Becomes Critical
Under any-occ, the insurer will commission a vocational analysis to identify jobs you allegedly could perform. A credentialed vocational expert on your side — one who reviews your actual functional limitations rather than hypothetical ones — is essential to rebutting insurer-favorable vocational reports.
Read moreFunctional Capacity Evaluation
A functional capacity evaluation (FCE) conducted by an independent physical or occupational therapist documents exactly what you can and cannot do in objective, measurable terms. An FCE submitted before the 24-month review gives the insurer less room to manufacture a different picture of your abilities.
Read moreTreating Physician Documentation
Generic physician letters saying you are “totally disabled” carry little weight. What moves the needle is a detailed statement that maps your specific functional limitations to the demands of any occupation — lifting, standing, cognitive load, attendance reliability, and ability to sustain work over a full workday and week.
Read moreProactive Review at Month 18
Waiting until you receive a termination notice is waiting too late. We recommend a comprehensive review of your claim file at month 18 — six months before the any-occ transition — to identify gaps, update medical records, and commission independent evaluations while there is still time.
Read moreMental-Nervous Cap at 24 Months
Separately, most group LTD policies also cap benefits for mental and nervous conditions at 24 months regardless of definition. If your disability has both physical and psychiatric components, the insurer may attempt to reclassify your claim at month 24 to trigger the mental-nervous limitation — even if physical impairment is primary.
Read moreHow we handle these cases
Step 1
Flag the 24-month transition date early and build a preparation timeline backward from it.
Step 2
Commission an independent FCE and vocational analysis before the any-occ review begins.
Step 3
Work with treating physicians to produce detailed, function-specific disability statements.
Submit a proactive evidentiary package to the insurer before the transition review
not in response to a denial.
Step 5
Challenge any attempt by the insurer to reclassify a physical claim as mental-nervous at the 24-month mark.
Real cases. Real results.
Three recent Long-Term Disability outcomes — case context and result. No client identifying information.
A project manager with chronic spinal stenosis faced the any-occ transition after 24 months. We submitted an independent FCE and a vocational expert rebuttal demonstrating that no realistic sedentary occupation was sustainable given her cognitive and physical limitations. Benefits continued without interruption.
An insurer attempted to apply the 24-month mental-nervous cap to a claimant whose primary diagnosis was a documented traumatic brain injury. We built the medical record around the neurological diagnosis and the psychiatric symptoms as secondary sequelae. The reclassification was withdrawn.
When a client’s benefits were terminated at the any-occ transition despite continued severe symptoms, we filed an administrative appeal with a comprehensive vocational and medical package. The insurer reversed the termination and reinstated benefits at the appeal stage.
Prior results do not guarantee a similar outcome. Each case is evaluated on its own facts. The case outcomes shown are representative examples; details have been altered or generalized to protect client confidentiality.
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Randy has litigated every type of claim before the Workers' Compensation Board on behalf of hundreds of claimants.
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Benai has spent more than a decade fighting for injured workers before the Workers' Compensation Board and the New York State Employees' Retirement Board.
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