Most disability insurance policies will contain both an “own occupation” and “any occupation” definition of disability. The own occupation definition is usually only for the first 24 months of disability. After 24 months, the claimant must re-qualify for disability benefits under the any occupation definition.
While most claim denials take place during the any occupation period, it is important for a claimant governed by California law to understand how “any occupation” has been defined by the court. Our California disability lawyers have helped thousands of claimants to receive disability insurance benefits during the any occupation stage of a disability claim. Let’s take a look at a case that goes back to 1938.
California Court Discusses “Substantial And Material Duties” In A Disability Policy
In 1938 Mr. Erreca was thrown from a horse, sustaining multiple fractures in his right leg, and tearing several ligaments in his knee. He remained in the hospital for two months, suffered a pulmonary embolism, needed crutches for several weeks, developed varicose veins, developed lesions and ruptured varicose ulcers. At trial he required the use of a cane, but could only walk for short periods of time without his legs swelling. He also had a permanent instability in his knee. Because of his forced inactivity, he gained 40 pounds and suffered from shortness of breath and an increased heart rate.
Mr. Erreca argued that he was totally disabled because he could no longer perform any of the manual labor required of him, nor could he manage or supervise farm operations. Western States Life argued that the Mr. Erreca was not totally disabled because he could do a long list of verbal duties (i.e. negotiations, signing of agreements, talking with employees). However, the court found that “[a]lthough such activities are neither trivial nor inconsequential, they are the type of duties that are infrequently and intermittently performed and cannot be said to constitute the substantial and material duties of the occupation of farming.”
Claimant Must Be Able To Work With “Reasonable Continuity” Or He Or She Is Disabled
The Erreca court also defined total disability in an any occupation policy as being, “a disability which prevents [the insured’s] working with reasonable continuity in his customary occupation or in any other occupation in which he might reasonably be expected to engage in view of his station and physical and mental capacity… such a disability as renders the insured unable to perform the substantial and material acts necessary to the prosecution of a business or occupation in the usual and customary way.” Absolute helplessness is not required; thus an insured’s ability “to perform sporadic tasks, or give attention to simple or inconsequential details incident to the conduct of business” does not preclude recovery. “Conversely, the insured is not totally disabled if he is physically and mentally capable of performing a substantial portion of the work connected with his employment. He is not entitled to benefits because he is rendered unable to transact one or more of the duties incidental to his business.”
The above law has been applied countless times by California courts. If you would like assistance with your disability insurance claim, then please contact us for a free phone consultation.