Long-Term Disability Own Occupation Provision

What Does “Own Occupation” Mean In Long-Term Disability?

If you have long-term disability insurance, you might be familiar with the term “own occupation”.  Many long-term disability policies incorporate the “own occupation” into their policies.  But what does this term really mean?  Before you are faced with the situation of not being able to work and trying to file a long-term disability claim, you should have a clear understanding of this provision.

Basically, long-term disability policies are designed to pay you a monthly benefit if you become disabled and are no longer able to work.

How Do I Determine If My Long-Term Disability Policy Considers Me Disabled?

It’s important to note that EVERY POLICY IS DIFFERENT!!  Every policy will likely have a different definition for what it means to be disabled.  Some policies will use the term “Total Disability” to refer to a person who cannot work. Other long-term disability policies may define a disability as an illness or injury that prevents you from working your “own occupation.”

“Own Occupation” Disability Insurance

If your long-term disability policy includes an “own occupation” provision, you may be entitled to receive disability benefits if you are unable to work at your “own occupation.”  An own occupation insurance policy will frequently cover workers whose disability makes them unable to perform the majority of the occupational duties they have been trained to perform.  Own occupation policy language will often look something like this:

“You will be considered disabled if you are unable to perform the material and substantial duties of your occupation, even if you are gainfully employed in another occupation.”

In some cases, you could be entitled to “own occupation” disability benefits even if you are able to find employment in another occupation.

Often, if the worker was not working at the time they were disabled, they will not be able to win a claim for benefits under a conventional own-occupation policy.  But, if the worker happens to have a modified own-occupational policy, they may still be covered even if they were not working when they became disabled.

For many policies, the “own occupation” period will usually last 24 months from the date you first receive benefits.  After that first 24 month period, policies will often switch to a more broad “any occupation” definition of disability.  As always, it is important to READ YOUR POLICY to determine which provisions apply to your specific situation.

“Any Occupation” Disability Period

The “any occupation” provisions of disability policies offers a much broader definition of disability and generally gives insurance companies more opportunities to deny your claim.  Some policies may have an “any occupation” provision which starts after the first 24 month of “own occupation” benefits and some policies may only offer benefits as a result of disability from any occupation.

Essentially, under the “any occupation” definition, you will usually only receive disability benefits if you are unable to perform any work that you are reasonably trained and qualified to do.  “Any occupation” language in a disability policy will often look something like this:

“You will be considered totally disabled if you are unable to perform all the substantial and material duties of any occupation for which you are fitted by education, training, and experience.”

What if I can’t understand my policy?

Disability insurance policies are difficult to understand.  But, we can help.  Give us a call and we’ll review your policy, explaining the policy’s clauses and how working might affect your benefits.