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What is an “own occupation” definition of disability?


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What is an "own occupation" Definition of Disability?

An own occupation provision, is the most favorable to an insured to have in a policy. With own occupation, the insurance company is going to constantly look at what job you were performing at the time you became disabled.

What one needs to understand is, you may have bought the policy 20 years ago and you were practicing medicine at that time. However you had a change of careers, you decided you wanted to pursue something else, and for instance, you decided to become a bricklayer. You become disabled at the time you were a bricklayer. The insurance company is not going to look to determine whether or not you can be a doctor any more, they are going to look at whether or not you can be a bricklayer. So own occupation will carry through constantly in transition. Maybe you bought the policy when you were a bricklayer; you went back and became a doctor. They are going to review it as if you were a doctor.

There are 4 opinions so far. Add your comment now.

Nick:

Why does it matter what occupation you hold at the time of disability?

Attorney Greg Dell:

Nick, good question. If you have a disability policy with an own occupation definition of disability, then the occupation you are performing when you become disabled is essential. With an own occupation definition the carrier will determine if you can perform the last occupation or occupations you were performing just before you became disabled. It is not the occupation you were performing when you bought the policy. If you don’t have an own occupation definition, then the carrier will only find you disabled if you cannot perform any occupation. The own occupation definition is a lot better for a disability claimant.

Jaime:

My long-term disability policy states:

“TOTAL DISABILITY or TOTALLY DISABLED means that an Insured Employee, due to an Injury or Sickness is unable:
1. during the Elimination Period and the Own Occupation Period, to perform each of the main duties of the Insured Employee’s regular occupation; and
2. after the Own Occupation Period, to perform each of the main duties of any gainful occupation for which the Insured Employee’s training, education or experience will reasonably allow.”

I am a 31 year old female who worked as a “Field Auditor” since approx. September 2007. I have been unable to work since March 2011 due to several chronic conditions (Gastroparesis, Cyclic Vomiting Syndrome, Irritable Bowel Syndrome, Gastroesophageal Reflux Disease, Depression, Anxiety, Hypertension, Tachycardia, Hypothyroidism, Sleep Apnea). I am currently under several doctors care for the abovementioned symptoms; however, medications have not helped the problems. My insurance carrier has continued to delay or deny my long-term disability based partly on a generic job description from the Dictionary of Occupational Titles (DOT). The insurance carrier is not taking into account the actual job description sent to them by my employer when the claim was initially filed in March 2011. I have listed a section from my most recent denial letter: “It is important to note that the policy under which you are covered refers to and is governed by the main duties of your regular “occupation” and not by the duties of your specific job. Nearly every job in the economy is performed slightly different from one employer to another. However, the Department of Labor groups jobs into occupations based on their similarities. The term “occupation” refers to a collective description of a number of individual jobs that are performed, with variations, in many establishments. Consequently, there will be similarities between the main duties of your occupation and those of your job. There may also be some differences.”

Is that correct? Can they use a generic job description? If so, why did they request a copy of my job description when the initial claim was filed?

The insurance carrier does not take into account that I worked in the field quite often. At times, I would drive long distances. Often times, I was unable to meet with clients because I was at home, sick. I missed deadlines because I was out of work, sick. I missed so many days due to illnesses that I was in a constant struggle with my supervisors to complete my work in a timely fashion. I was at home or the doctor’s office more than I was at work.

Until my doctor can figure out a cure or help alleviate my symptoms, I am unable to return to work. I have paid into my disability insurance for several years and believe that the benefits should be there when/if you need them.

Attorney Greg Dell:

Jaime,

You are asking some very specific questions which require us to review your policy. If you have received a denial letter, then you could send it to us and we will call you to discuss your options.

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