The Difference Between Own and Any Occupation in Long-Term Disability Insurance
“Own Occupation” is a term used in the definitions of total and residual disability in long-term disability insurance. In these definitions, own occupation means the specific occupation you are engaged in at the time you became disabled. Most policies provided to medical and dental professionals and lawyers define “own occupation” as the specific specialty you practice within your field.
Many individuals who have own occupation coverage in their long-term disability insurance policy often believe it means the occupation they performed at the time their coverage was issued, the general occupation for which they are trained, or the specific job position they hold. Many professionals also believe 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.
At Seltzer & Associates, we can assist you in reviewing and understanding how own occupation coverage in your policy applies to your unique situation. It is important to review your specific policy and understand the definition of 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 with the highest likelihood of being approved by your disability insurance company.
“Any Occupation” is a term used in the definitions of total and residual disability in long-term disability insurance. Any occupation coverage generally means you are eligible for disability insurance benefits if due to your sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably qualified based upon training, education, and experience.
While this may feel similar to Social Security’s definition of disability and substantial gainful activity, it is important to note the differences. Many long-term disability insurance policies also include language that requires your actual qualifications, work experiences, and pre-disability income to be taken into consideration when evaluating your ability to perform any occupation, in contrast to Social Security.
In most long-term disability insurance policies, own occupation coverage only applies for a limited period of time, often two years. Following this limited period of time, you will only remain eligible to continue to receive disability benefits if you meet the any occupation coverage definition.
At Seltzer & Associates, we can assist you in reviewing and understanding how any occupation coverage in your policy applies to your unique situation. It is important to review your specific policy and understand the definition of any occupation as it appears in your policy. Your disability insurance company will employ vocational specialists to perform an analysis to determine what gainful occupation you are reasonably qualified for. You must understand what the duties of any occupation you may be qualified for, and how they relate to your medical condition. We have found at Seltzer & Associates that claims and cases involving an any occupation definition, at some time in the claims process are often most aggressively challenged by the companies and can be extremely difficult to navigate, defend or prosecute. It is imperative that you understand that your disability insurance company will often use the broad definition of any occupation as a vehicle to limit, deny, or terminate your claim. We will help you with this analysis in order to understand your disability insurance company’s position and how to present your claim in the strongest possible way.