The Standard Insurance Company sells multiple different long-term disability policies to dentist and other medical professionals. The difference in each policy is usually the definition of disability. In my opinion, the following definition of Own Occupation Disability sold by Standard is called an Own Occupation definition, but it is not a true Own Occupation policy. The following definition of Own Occupation is misleading and essentially requires the policy holder to be unable to work in any occupation.
Our law firm has represented numerous claimants that have purchased a long-term disability policy from Standard with the following definition of Own Occupation:
The Own Occupation Definition of Disability is as follows:
During the Benefit Waiting Period and the Own Occupation Period you are required to be Disabled only from your Own Occupation.
You are Disabled from your Own Occupation if, as a result of Physical Disease, Injury, Pregnancy or Mental Disorder:
- You are unable to perform with reasonable continuity the Material Duties of your Own Occupation; and
- You suffer a loss of at least 20% in your Indexed Predisability Earnings when working in your Own Occupation.
During the Own Occupation Period you may work in another occupation while you meet the Own Occupation Definition Of Disability. However, you will no longer be Disabled when your Work Earnings from another occupation meet or exceed 80% of your Indexed Predisability Earnings. Your Work Earnings may be Deductible Income. See Return To Work Provisions and Deductible Income.
Own Occupation means any employment, business, trade, profession, calling or vocation that involves Material Duties of the same general character as the occupation you are regularly performing for your Employer when Disability begins. In determining your Own Occupation, we are not limited to looking at the way you perform your job for your Employer, but we may also look at the way the occupation is generally performed in the national economy. If your Own Occupation involves the rendering of professional services and you are required to have a professional or occupational license in order to work, your Own Occupation is as broad as the scope of your license.
Material Duties means the essential tasks, functions and operations, and the skills, abilities, knowledge, training and experience, generally required by employers from those engaged in a particular occupation that cannot be reasonably modified or omitted. In no event will we consider working an average of more than 40 hours per week to be a Material Duty.
The Standard’s idea of calling this policy Own Occupation disability is like giving someone a cubic zirconia and telling the person it is a diamond. This definition of Own Occupation should be illegal. A traditional Own Occupation definition states that a person is disabled if they are unable to perform the substantial and material duties of their own occupation. Own Occupation has always been interpreted as the claimants pre-disability duties at the time he or she becomes disabled. For example, if a dentist has a disabling hand condition and can no longer perform procedures on patients, then this dentist would be considered disabled. This dentist could continue to be disabled so long as she does not treat patients as she did pre-disability. Under the Standard’s definition of Own Occupation disability, if the same dentist is able to perform any job within the scope of her dental license, then she is not disabled. So, if the dentist can teach dentistry or perform dental medical reviews, then the Standard would argue that this person is no longer disabled. In a recent letter to a dentist the Standard stated:
The Own Occupation definition can encompass any and all occupational endeavors he can perform under the broad scope of his license as a dentist. This could involve administrative positions, nonsurgical positions, and/or other sedentary level positions consistent with his dental license.
Furthermore, Standard will reduce the monthly disability benefit by the amount of any income that the dentist earns. With a traditional own occupation definition a dentist would be able to work in another job within the scope of her dental license and still collect the full monthly disability benefit. Essentially, Standard sells a policy that states Own Occupation, but when it comes time to file a claim if you can do any job within the scope of your license, then Standard will fight your claim.
Prior to filing a claim for long-term disability we always recommend that a claimant consult with a disability attorney in order to explain the true meaning of all terms in your disability policy. Not every policy from The Standard contains the same language, but the Standard should be embarrassed by its inappropriate usage of the word Own Occupation.