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Understanding “Own Occupation” In Long-Term Disability Policy

Posted in ERISA, Long Term Disability. Tuesday, Dec 27th, 2016

In every long-term disability insurance policy, there is a clause that specifically defines what a disability is according to each individual provider. For some providers, a long-term disability is defined as a disability that hinders a person’s ability to perform any occupation, which means that an individual will only receive long-term disability benefits if they cannot work at all. Other policies define a disability as a condition that impedes an individual’s ability to perform their own occupation. And yet more policies mix the two, and define disability as a condition that hinders one’s ability to perform their own occupation, but after 24 months of disability, the definition switches to any occupation. Both employer-sponsored ERISA plans and individual policies have these varying definitions, though it is more common for private policies to use the “own occupation” definition.

What Does “Own Occupation” Mean?

While it may seem straightforward – for instance, if you were an accountant for a law firm, your occupation would be just that, right? – in reality, of course, it is not. Everything that insurance companies do is financially driven, and as a result, they have developed complex strategies to either find a way not to pay, or to significantly reduce an individual’s settlement. One of their strategies is to make defining your own occupation a rather difficult task.

To begin, your “own occupation” is determined at the time of your injury, and not at the time you applied for your coverage. This means that if you were an accountant for a law firm when you applied for your coverage, but then switched professions entirely to become a high school math teacher, your “own profession” will be noted as a high school math teacher. This will affect how much you receive in benefits and what the insurance company deems you capable and incapable of doing.

Your Occupational Duties

In order to determine whether or not you are “disabled” by your insurance policy’s standards, the insurance company will want to know if you can perform the material and essential duties of your “own occupation.” In order to determine this, they will conduct a thorough assessment of your actual duties as a high school math teacher. From lecturing a group of students to grading assignments at home, and meeting with other staff members to developing a curriculum, every aspect of your job will be considered. The insurance company will want to know how much of your time you dedicate to each aspect in order to give it a monetary value. If they determine that your disability only hinders you from performing one or two essential job functions, and if they are functions that you do not spend a significant amount of time on, they may deny your claim or offer very little in the way of benefits.

Consult with a Columbus Long Term Disability Lawyer

At the Law Office of Mike Gertner, our long-term disability attorneys know just how confusing long-term disability policy definitions can be. The insurance companies purposely make them that way in order to more easily manipulate policyholders into assuming that they are not covered for their particular condition. If you are disabled and want to file a claim with your insurance company, or if you have already filed a claim and been denied, contact our Columbus long-term disability lawyers at 614-463-9393 to schedule a consultation today.