“OWN OCCUPATION” vs. “ANY OCCUPATION”
Understand how “own occupation” and “any occupation” disability laws work
Is your long-term disability policy an own occupation policy, an any occupation policy, or both?
The first thing to do is request a copy of your long-term disability policy (whether governed under ERISA, or state law). When requesting a copy of your long-term disability policy, you want to request this in writing and send the letter to the insurance company by sending it certified, return receipt mail. This will be proof that you requested the policy in writing, if you need to prove you requested a copy and never received a copy. Remember, it’s your policy and your entitled to a copy. In fact, ERISA requires the insurance company to send you a copy.
There are various types of disability insurance policies.
Most ERISA insurance policies have disability definitions for the individual’s own occupation for a period of time then the definition changes to any occupation. When reviewing your long-term disability policy, one of the most significant definitions you will see will be whether the policy has an own occupation disability provision or an any occupation disability provision. Policies with an own occupation provision usually pay for a certain period of time if the individual is found to be disabled from their own occupation (what they were doing at the time their disability began and they stopped working).
The language disability insurance companies use is intentionally vague, confusing and overwhelming. Going through your policy can be like trying to find your way out of a maze.
Unfortunately, the insurance industry does not regulate the various terms used in long-term disability policies. One carrier’s definition of an own occupation is not necessarily the same as that of another carrier. Therefore, it is very important to know your long-term disability policy definitions. If you need assistance, our office of experienced ERISA disability lawyers is happy to help. You can call (615) 234-6000, or e-mail cody@codyallison.com.
If the insurance carrier finds you disabled and pays you benefits for your own occupation, after a certain period of time, the definition changes to any occupation.
What this means is, after you own occupation period is over with, you must now qualify for disability under the any occupation definition in your policy. This is where most people get denied any further disability benefits, after their own occupation period has expired. If the insurance company feels that you can work in any occupation based on your condition (disability), education, training, and experience, then they will deny you any future benefits, say you can work, and send you a denial letter telling you that you have a right to appeal and that you will not receive any more long-term disability benefits. As far as the insurance company is concerned, they have reviewed your medical records, and determined that you can work.