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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 so you can understand how it defines disability, including whether it follows an own occupation vs. any occupation standard. Whether your claim is governed by ERISA or state law, you should request the policy in writing and send the letter to the insurance company by certified mail with return receipt requested. This creates proof that you asked for the policy in case the insurer later claims it was never requested or never sent. Remember, it is your policy and you are entitled to a copy. In fact, ERISA requires the insurance company to provide it upon request, and an experienced ERISA attorney can help you review it and explain how those definitions apply to your claim.
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).
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.
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.
Own Occupation vs. Any Occupation Disability Claims — Contact Us for Help
At Cody Allison and Associates, we have extensive experience defending our clients’ rights in own occupation vs. any occupation disability claims, including both ERISA and non-ERISA cases. We know how insurers apply these definitions and how to use the long-term disability forms your doctors must complete to properly support your claim. We fight aggressively against disability insurance companies to pursue the benefits you paid for. If you need guidance with an own occupation or any occupation denial, contact us to discuss your situation.