Own Occupation vs Any Occupation Disability: What You Should Know

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back painWhen it comes to long-term disability insurance, few areas are as confusing and difficult to overcome as how the insurance policy defines a disability. Disability insurance falls into two primary categories: own occupation policies and any occupation policies. The type of policy you have will have a dramatic impact on whether the insurance company even considers you disabled. Here’s what you should know about the difference between these two types of disability claims.

What is Own Occupation vs Any Occupation?
When the policy covers “own occupation” disability, it means your policy requires that you be unable to perform the duties of your particular occupation to be classified as totally disabled. More commonly, disability insurance uses the “any occupation” standard. This means disability is defined much more broadly to the inability to perform any occupation for which you are reasonably suited based on your work experience and education.

With most long-term disability group insurance policies, the policy offers benefits under the “own occupation” disability definition for the first two years. To continue receiving disability benefits, you must be considered disabled under the “any occupation” standard.

Without the “own occupation” coverage, you face the risk that the insurance company may decide you could work in some other capacity. This is especially important if you have a high level of skills or training that could lead the insurance company to determine you are able to work in another occupation, even if you would be unable to perform your current job.

What is Your Own Occupation?
While the “own occupation” clause is fairly specific in terms of defining your disability, it does leave room for question. An experienced LTD attorney will argue that your policy’s “own occupation” definition should be limited to the exact work you were doing at your job when you were hurt, not an occupation performed in a similar setting in the general industry in which you worked.

There are also two types of “own occupation” clauses: one states that you are disabled when you can no longer perform the duties of your own job but you are not gainfully employed in another area, while a “true own occupation” definition just means you can’t perform your own occupation. In the latter case, you can still find employment in another industry without sacrificing your disability benefits. This type of “own occupation” clause is most favorable but it’s rarely found in group insurance plans.

The “own occupation” clause is an important form of protection as it can also give you the ability to work in another field if you can. If you find work in another industry, you can still receive long-term disability benefits under this clause without negative consequences. As an example, a surgeon who is determined to be totally disabled and unable to perform his or her own occupation could work as a general practitioner and still receive disability benefits.

Understanding how your insurance company defines disability is crucial and every insurance company is different. It’s important to work with a long-term disability attorney who has extensive experience handling LTD claims to help you build a strong case. Contact Edelstein Martin & Nelson today for a free consultation with a Philadelphia long-term disability lawyer to discuss your case.

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