Own Occupation vs. Any Occupation: What It Means for Your Disability Claim
If a serious illness or injury stops you from working, you will likely have a lot on your mind, including concerns about how to pay your bills. Disability insurance benefits can help fill the gap and sustain you financially in those circumstances.
Please note that not all disability policies work the same way. One of the most important differences is how a policy defines disability. You should know how your policy treats own occupation vs. any occupation disability. That distinction can determine whether you receive benefits and how long they last. Speaking with an experienced benefits attorney can help you understand your options and seek the maximum amount of coverage available.
Attorney John Robert Peace of the Peace Law Firm has been serving the people of South Carolina for more than 20 years and is top-rated among his clients. The Peace Law Firm will work to protect your interests in any disability insurance claim and maximize potential benefits.
What Is Disability Insurance Coverage?
Disability insurance replaces part of your income when a medical condition prevents you from working. There are two types of coverage:
Each type of coverage is designed to help you pay for everyday expenses, such as housing, food, and medical care, when you can no longer earn a paycheck. The amount of coverage, the length of benefits, and the definition of disability all depend on your specific plan terms.
How Is Disability Insurance Coverage Paid For?
Disability coverage is often offered through an employer as part of a benefits package. Employers may pay the full cost of the policy or share the cost with employees through payroll deductions. If you are unsure about whether you have coverage and who is paying for your benefits, consult a legal professional who can review your pay stubs and employee benefit documents. At the Peace Law Firm, our team can help you navigate these documents and identify your options for financial support in times of illness or injury.
Policy Definitions for Own Occupation vs. Any Occupation Disability
Every disability claim starts with a key question: How hurt do I have to be to qualify for benefits under my plan for long-term disability? The definition of “disability” that many long-term disability plans use typically takes one of two forms: own occupation disability or any occupation disability.
Own Occupation Disability
An “own occupation” definition of disability generally means you are considered disabled if you cannot perform the duties of your specific job. For example, imagine a surgeon who develops a hand condition that prevents them from performing surgery. Although the surgeon may still be able to work in another role, such as teaching or consulting, they could still qualify as disabled under a plan that uses an own occupation definition of disability, since they can’t fulfil the core duties of their original job.
Any Occupation Disability
An “any occupation” definition of disability is more restrictive. Under this standard, you are considered disabled only if you cannot perform the substantial duties of any other work you are reasonably qualified to perform.
Depending on the policy language, the insurer may evaluate:
- Your medical records,
- Education,
- Training,
- Transferable skills, and
- Work experience.
Some policies require that alternative work meet a certain earnings level compared to your prior pay. Others use broader terms like “gainful occupation.” The exact threshold depends on the plan.
Sometimes, a long-term disability policy will use one of these two disability definitions for the entire claim. Other times, a policy will grant benefits for own occupation disability for a period of time (e.g., one year), after which it changes to an any occupation definition of disability for continued benefits. Many claim denials occur when a policy shifts from an own occupation standard to an any occupation standard. So, understanding own occupation vs. any occupation disability is critical when evaluating a claim or an appeal.
How Do You Qualify for Coverage?
To qualify for disability benefits, you must meet both medical and policy requirements. And you will likely have to provide written medical evidence showing that your condition prevents you from working under the applicable disability definition. This often includes:
- Medical records,
- Physician opinions, and
- Functional capacity information.
You must also comply with plan rules, including notice requirements, filing deadlines, and proof-of-loss provisions. Employer-sponsored disability plans are often governed by federal ERISA regulations, which impose strict procedural requirements and appeal deadlines.
Missing a deadline or failing to submit the right documentation can jeopardize an otherwise valid claim. The Peace Law Firm can help you navigate plan regulations and requirements and file a timely case for the benefits you deserve.
Let Us Take Care of You
You work hard for your benefits, and you should be able to relax about financial matters when handling a debilitating condition. At the Peace Law Firm, we care about your needs and your comfort. John Peace has been a leader in the South Carolina legal community for over a decade, and he has the tools to protect your interests. Please contact our office by phone or online to schedule a consultation.
Resources:
- ERISA, U.S. Department of Labor, link.
- Individual Accident and Health Insurance Minimum Standards, “Total Disability,” S.C. Code Regs. § 69-34 E.(9)(a), (p. 145), link.
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