Own-Occupation vs Any-Occupation: What It Means for Your LTD Claim in Philadelphia

Long-term disability benefits (LTD) are designed to protect you when illness or injury prevents you from working. But if you’ve filed or are considering filing an LTD claim in Philadelphia, you’ve probably run into some confusing policy language. Two terms matter more than most: “own occupation” and “any occupation” disability ”. These definitions determine whether you qualify for benefits, how long you’ll keep receiving them, and what obstacles you may face along the way.

Because many denials in Pennsylvania come down to how insurers interpret these definitions, understanding them is essential. This article will  explore the difference between own and any occupation disability, look at the 24-month change-of-definition issue that trips up so many claimants, and review what kind of evidence you’ll need to prove your functional limits.

Own Occupation Disability in Philadelphia LTD Claims

At the start of many LTD claims, the insurer asks whether you can perform the material and substantial duties of your own occupation. This standard is called the own occupation disability definition.

Take an accountant working in Center City as an example. Their  occupation involves long hours at a computer, analyzing data, and preparing detailed financial reports. If they  develop carpal tunnel syndrome or a neurological condition that prevents them  from handling these tasks, they  may qualify as disabled under the own-occupation definition—even though they  could technically perform another kind of job.

Policies can define “own occupation” in slightly different ways. Some focus on whether you can perform your actual job duties as they exist in real life. Others look at whether you can perform the duties of your occupation as it is generally performed in the national economy. For Philadelphia professionals, that distinction can mean the difference between approval and denial of LTD benefits.

The impact of these definitions can vary dramatically depending on your line of work. Consider a paralegal in Center City who develops multiple sclerosis. They may still walk but cannot keep up with deadlines due to fatigue and cognitive decline. Under the own-occupation standard, they qualify for LTD. Once the policy changes, however, the insurer may argue they can handle less demanding clerical work. Detailed medical evidence of their cognitive limits becomes essential.

Any Occupation LTD Claims in Pennsylvania

After the own-occupation period ends—usually at 24 months—most LTD policies shift to the tougher any occupation disability definition. At this stage, you must prove that you cannot perform the duties of any job for which you are reasonably suited by education, training, or experience.

That doesn’t mean the insurer can deny you just because you could theoretically sweep floors or work part-time in a low-paying role. Courts require that “any occupation” be gainful, which means the work should provide a reasonable income based on your background. Still, the standard is much harder to meet.

Imagine a construction worker from Brewerytown who suffers a permanent back injury. They  can’t return to heavy labor, but the insurer may argue they  can do sedentary desk work. Unless they  provide medical evidence showing that sitting for extended periods is unrealistic, their  LTD benefits could be cut off.

Similarly, a marketing executive in Center City with severe depression may be told they  can work in a clerical job. Without strong medical documentation of her concentration problems, they  risks losing coverage once her policy changes definitions.

Now imagine a plumber from Fishtown with a severe back injury. During the own-occupation phase, they qualify because they cannot climb ladders or lift heavy tools. After the change, the insurer may claim they are capable of desk work. Yet their physician may document that sitting for more than fifteen minutes causes debilitating pain, proving that sedentary roles are not realistic either.

These real-world scenarios show why understanding one’s own occupation disability vs any occupation is not just a matter of policy language—it’s about survival for people whose livelihoods are on the line.

The 24-Month Change of Definition in LTD Claims

The 24-month change-of-definition point is one of the most stressful moments in the LTD claim process. For the first two years, your eligibility is typically measured against the own-occupation standard. After that, most insurers re-define disability using the stricter any-occupation language.

This shift often triggers aggressive re-evaluations. Many claimants in Philadelphia suddenly receive notices scheduling independent medical exams, vocational assessments, or even surveillance. Insurers use these tools to argue that you are capable of some type of gainful work, even if it’s not the job you previously held.

For many people, this change feels like the rug is being pulled out from under them. Their condition hasn’t improved, yet their LTD benefits are threatened simply because of a policy definition. Understanding this transition—and preparing for it early—is key to protecting your rights.

Proving Functional Limits in LTD Claims

Whether your LTD case is being reviewed under the own-occupation or any-occupation standard, the most important step is proving how your condition limits your ability to work. Diagnoses alone are rarely enough; insurers want concrete evidence of functional restrictions.

Treating physicians can provide detailed letters describing the limits caused by your condition. For instance, a neurologist may explain how a stroke survivor’s memory and attention issues make it impossible to perform complex financial tasks.

Residual Functional Capacity forms also help by outlining what you can and cannot do during a workday. A roofer with advanced arthritis might show documented restrictions on climbing, lifting, or standing.

Some claimants undergo Functional Capacity Evaluations, where specialists measure their physical ability to perform work-related tasks. These evaluations often rebut insurer arguments that sedentary work is realistic. For cognitive issues, neuropsychological testing provides objective data showing deficits in memory, attention, or processing speed.

In certain cases, vocational experts play a role by analyzing whether your skills, combined with your medical restrictions, allow you to realistically transition to other jobs in the Philadelphia labor market. If not, their report can make your case much stronger.

Why Philadelphia LTD Claimants Need Local Help

Philadelphia’s workforce is diverse, ranging from law firm employees in Center City to construction workers along the Schuylkill. Insurers don’t always account for how specialized or physically demanding these jobs really are. Too often, they try to fit claimants into generic occupations that don’t exist in the actual Philadelphia job market.

That’s where local experience matters. A Philadelphia LTD lawyer knows how insurers operate and how to push back with the right documentation. They can coordinate with your doctors, arrange for appropriate testing, and enlist vocational experts who understand the regional economy. This is especially valuable when you’re facing the 24-month change-of-definition, where so many claims are wrongly terminated.

Talk to  Edelstein Martin & Nelson Lawyer About Your Disability Claim

If you’re facing questions about your own occupation disability or any occupation LTD claims in Philadelphia, you don’t have to go through it alone. The change of definition is one of the most common reasons insurers cut off benefits, but with strong medical evidence and skilled legal guidance, you can fight back.

Whether you’re a desk worker in Center City or a hands-on tradesperson in Fishtown, your future depends on protecting your rights. Don’t wait until your LTD benefits are denied. Speak with an experienced Philadelphia disability insurance lawyer at Edelstein Martin & Nelson who can help you navigate the claim process, prove your functional limits, and secure the financial support you need to move forward.