In this video Marc Whitehead, Board Certified Disability Attorney, explains the Own Occupation Standard in Long Term Disability Insurance Claims.
ERISA regulations allow insurance companies to use specific standards to determine whether or not a person claiming a medical disability is able to work. When you initially file this claim and go through the process, they’ll be using the Own Occupation Standard. As the name implies, your insurer will attempt to see if you are able to do the work required of your current job.
The Standards for different types of jobs are laid out and defined in the Dictionary of Occupational Titles (DOT).
Example: If you have been a construction worker for the last decade they’ll try to determine if you’re able to lift heavy objects and engage in physical labor. Construction, which is considered heavy work, requires you to be able to lift and carry at least 100 pounds. If some kind of injury or impairment is keeping you from doing it, then you would be considered disabled under the Own Occupation Standard.
ERISA regulations allow insurers to have different definitions. While job standards are Nationally defined and are always the same for everyone, each insurer is allowed to interrupt and determine how they will cover disability for someone who doesn’t meet the Own Occupation Standard.
Most medical disability policies will only cover you for an inability to do your specific job for only 24 months. While 2 years isn’t bad if you are suffering from some kind of impairment that will clear up with surgery, rehab or both.
What happens if it is a Long Term Disability?
In that case, most insurers switch over to a much more stringent standard the Any Occupation Standard.
This is why it is important to have an experienced Attorney working on your claim. They will not only assist you in fighting for your Own Occupation benefits but they’ll be able to request medical documentation, medical reviews, and independent examinations in order to ready your claim for the Any Occupation period that follows.
