Some individual disability insurance policies define “own occupation” slightly differently than the traditional “own occupation” definition. This definition, which has come to be known as “Modified Own Occupation” means you are unable to perform the specific occupation you were engaged in at the time you became disabled, and not working in another occupation. Just as with traditional “own occupation” definitions, most policies provided with “modified own occupation” to medical and dental professionals and lawyers define “own occupation” as the specific specialty you practice within your field. Sometimes “specialty letters” specifically providing this explanation were provided with your policy when it was issued.
Many individuals who have modified own occupation coverage in their Individual Disability Insurance policy often believe it means the occupation they performed at the time their coverage was purchased or the general occupation for which they are trained. Many professionals also believe modified own occupation coverage strictly means their professional occupation, while the disability insurance company may argue they have multiple occupations such as administrator or executive in addition to their professional occupation, or those other occupations compromise some or all of the material and substantial duties of their occupation.It is especially important to understand these nuances for a “modified own occupation” definition as you may no longer be able to perform the job you believed to be your occupation, but you are performing a different occupation.
At Seltzer & Associates, we can assist you in reviewing and understanding how modified own occupation coverage in your policy applies to your unique situation. It is important to review your specific policy and understand the definition of modified own occupation as it appears in your policy. It is imperative that you have a full understanding of what your material and substantial duties are in your own occupation and how the company in its assessment will view your duties and your occupation. We will help you with an analysis of how your medical condition relates to the important components of your occupation in order to present your claim in the strongest possible way.