Many disabled individuals get blindsided by strict policy definitions that allow insurers to deny valid claims. The key distinction often comes down to “own occupation” versus “any occupation” disability insurance coverage.
Own occupation policies provide comprehensive income protection by paying benefits if you cannot perform your specific occupation’s duties – even if you can work another job. In contrast, any occupation plans hold you to an extremely narrow definition that can force you into lower-paying work far beneath your skills and earnings potential.
Working with an experienced long-term disability lawyer can help you gain a better understanding of your rights under each policy type.
What Is an Own Occupation Disability Policy?
An own occupation disability insurance policy is designed to provide comprehensive income protection if you become unable to perform the core duties of your specific occupation. It continues paying benefits regardless of your ability to work another job or career – safeguarding your higher earnings potential.
A Policy Definition to Understand
The critical factor is how the insurance policy contractually defines “total disability.” With your own occupation definition, you meet these criteria if you cannot perform the material and substantial duties of the occupation you were working in at the time of disability.
There are no requirements about being completely unable to earn an income elsewhere.
Advantages of Own Occupation Coverage
Own occupation disability coverage offers several crucial advantages over more limited policy definitions:
Income Security Despite Career Change
Even if you end up taking a new position or career path due to your disabling condition, you can continue receiving full benefits with no offsets or reductions. This provides financial flexibility to recover, retrain, or try a new profession you’re passionate about without being forced to take the first available job.
No Offsets for Outside Income
Any income you earn from a new occupation will not be deducted or offset from your own occ disability benefits. This allows you to supplement the insurance payments as you’re able without penalty.
Portable Benefits Through Job Transitions
Since own occ coverage is based solely on your inability to perform your prior occupation’s duties, the benefits are portable through any number of job changes or employer transitions before experiencing a disabling condition.
The Limitations of Any Occupation Disability Insurance
In contrast to own occupation policies, any occupation disability insurance has a much stricter definition of total disability that severely limits when benefits get paid. Here are some of the major drawbacks:
Narrow Definition Denies Many Valid Claims
Any occ policies deny benefits if the insurance company decides you have the basic education, skills, and experience to perform any reasonable occupation – regardless of whether it leverages your specialized training or not.
Fails to Protect Earnings & Advancement Potential
You could be forced into taking an available job that pays substantially less than your previous occupation and career path. Any income would also be deducted from the disability payments.
Challenging Process to Qualify for Benefits
Insurance companies take an adversarial approach, requiring extensive documentation and aggressively interpreting policy language to deny as many claims as possible under the strict OCC requirements.
The Difference Between Own Occupation and Any Occupation Disability Benefits
Consider these scenarios that exemplify the limitations of any occupation disability coverage:
- A surgeon who injures their hands would be denied any occ benefits and forced to take a lower-paying clinical or administrative role in the medical field
- A commercial airline pilot with vision issues would not qualify for any occ benefits because they theoretically could work in another field that doesn’t require them to meet the vision standards for flight qualification.
Own occupation policies would allow these highly-skilled professionals to retain their income level and potentially retrain for a new career rather than having to settle for whatever lower-skilled job the insurance company deems “reasonable.”
How a Long Term Disability Attorney Can Help
Employing an experienced disability lawyer can make a major difference whether you:
- Have an own occ policy and want to ensure you receive all benefits owed
- Need to appeal any occ claim denial by building a strong medical and vocational case
- Want to explore all legal options for your individual situation
Our attorneys will analyze your policy’s specific language and leverage our knowledge in this complex area of insurance law. This includes:
- Advising you on what medical evidence and documentation is needed to meet your policy definition
- Pushing back against aggressive insurers who question the extent of your disability
- Negotiating a fair lump sum settlement in appropriate cases
- Filing a lawsuit if needed as a last resort to recover full benefits wrongfully denied
Contact a Disability Lawyer to Learn More About Own Occ vs. Any Occ Disability Benefits
Insurance companies are motivated by profits, not getting you the support and benefits you desperately need. They’ll put up roadblocks at every turn, hoping you’ll just give up and go away. With so much at stake financially, it’s wise to have a dedicated long-term disability lawyer advocating for your rights. Contact Marc Whitehead and Associates to learn more.
