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What is the Difference Between “Own Occupation” and “Any Occupation” Coverage?

What is the Difference Between “Own Occupation” and “Any Occupation” Coverage?

When you apply for long-term disability (LTD) benefits through your ERISA-governed LTD insurance plan, you normally must prove that your medical conditions make you unable to work in your own occupation or job. This means that due to your illness, injury, or medical condition, you are unable to perform the essential tasks of the position that you hold.

In many, if not most, LTD policies, however, the disability standard changes over time. Generally, after individuals receive 24 months of LTD benefits, many LTD policies then require evidence that not only do your disabilities prevent you from performing your own occupation but they also prevent you from performing ANY occupation. The expansiveness of this standard, which encompasses nearly any type of job, no matter how unsuitable or low-paying it may be, makes it extremely difficult to prove that you continue to be eligible for LTD benefits.

Although a 24-month period of benefits based on an inability to perform one’s own occupation is typical in LTD insurance policies, this period can vary from as little as 12 months or as much as 36 months before the standard of disability changes. Furthermore, policies may differ in definitions of “own” or “regular” occupation and “any” occupation, so you need to be familiar with your policy’s specific definitions of these terms to gauge your ability to meet the applicable standard, both now and in the future.

For example, all too often, your insurance company may interpret your “own” or “regular” occupation as requiring far less physical activity, sitting, standing, or other tasks than it realistically requires. As a result, the insurance company may determine that you still are able to meet the requirements of your position, even taking into consideration your disabling conditions. Therefore, you should not just rely on your job description to give the insurance company information about your job responsibilities and duties. Rather, you should write out your own description of your daily duties and responsibilities and ask your supervisor to do the same

Bonnici Law Group provides client-focused representation throughout the ERISA claims process. We are here to consider the evidence in support of your ERISA long-term disability claim, evaluate your claim, and develop the strongest and most effective strategy for fighting any denials of coverage that you may receive. Allow us to handle your legal needs while you focus on your physical and emotional health. Contact the ERISA long-term disability attorneys of Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

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