any occupation

When most of us think about “disability,” we define the term simply: you can’t work because of an illness, medical condition, or injury. However, when you apply for long-term disability insurance, you’ll discover that “disability” can mean many different things, depending on your policy.

Unfortunately, many disabled individuals don’t realize that their policy’s language can have a profound impact on their right to benefits. This lack of understanding can lead to a lot of frustration and denied benefits. In this blog article, our disability insurance lawyers break down the difference between “own occupation disability” and “any occupation disability.”

Read Your Long-Term Disability Plan Document

A long-term disability (LTD) policy is a contract. Either you or your employer agreed to the terms in the contract when they bought the coverage, even if you didn’t read them. When you apply for long-term disability benefits, these terms and conditions will affect when you apply, whether you’ll get monthly benefit payments, and how much you’ll receive.

If you apply for disability insurance benefits before reviewing your policy’s standards and processes, you’ll be at a serious disadvantage. To get started, you should request the following documents:

  • Plan Document: Details every term, condition, and process that applies to your policy; Plan Documents are often dense and difficult to read
  • Summary Plan Description (SPD): Outlines the key elements and procedures of your long-term disability plan in an easier to read format

While you may prefer reviewing the SPD, your disability lawyer will probably dig into the precise language of the Plan Document.

One of the most important issues outlined in your LTD policy is its definition of disability. If you don’t meet the definition, you cannot receive benefits. While every policy has unique quirks, most lawyers break disability definitions into two categories: own occupation disability and any occupation disability.

Own Occupation Disability Focuses on Your Actual Job

Own occupation and regular occupation policies will pay your long-term disability benefits if you can prove that you are unable to perform the primary duties of your current job because of an illness, injury, or chronic medical condition.

For example, a surgeon with severe nerve damage in their hands may be unable to perform surgery. Even if the surgeon could take on different, less hand-intensive work, they should get disability benefits under an own occupation disability insurance plan.

Compared to “any occupation” disability plans, it’s easier to get disability insurance benefits under an own occupation plan since you only have to show that you’re unable to perform the substantial duties of your specific occupation. You also may be able to perform simpler or lighter work and still get the benefits you need.

For this reason, insurance companies tend to avoid the “own occupation” definition of disability in long-term disability policies. (It is much more common in short-term disability plans.) However, if you have an individual disability insurance policy that you purchased, you may have an own occupation definition in your Plan Document.

What’s My Occupation?

If you have an own occupation disability policy, don’t be surprised if the insurance company tries to categorize your work in a way that’s inaccurate. Insurance adjusters often try to describe your job as broader and easier than your specific occupation. If this occurs during your disability claim, your disability lawyer will typically work with vocational experts, assessing your job description, essential duties, and employment records to determine how to categorize and define your occupation.

Insurance Companies Often Add Limitations to Own Occupation Policies

Because a true own occupation policy is relatively lenient, insurance companies often try to add qualifications and limitations to these definitions. When you review your Plan Document or Summary Plan Description, look out for these more restricted versions of an own occupation policy.

  • Modified own occupation: You must show that you cannot perform your actual job and you are not working in any other occupation.
  • Transitional own occupation: This definition of disability requires that you cannot perform your actual job and are not earning more than your pre-disability income.

Other times, you may receive a partial long-term disability benefit if you have returned to work.

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Any Occupation Disability Usually Requires Total Disability

Any occupation definitions of disability are common in long-term disability plans. Insurance companies prefer the any occupation definition because it makes it harder for individuals to receive benefits. If your policy contains “any occupation” language, you must prove that you’re unable to perform the substantial duties of any occupation, not just your own job.

For example, let’s revisit the surgeon with severe nerve damage in their hands. Suppose that the surgeon’s work restrictions limit repetitive use of their hands, gripping, and grasping, but they are otherwise healthy. While the doctor is unable to perform surgeries, the insurance company will argue that they have other options, like teaching at a medical school, telemedicine, or even simple jobs outside the medical profession.

Look for “Gainful Occupation” Language in Your Long-Term Disability Policy

Some long-term disability policies define disability as being unable to perform any gainful occupation. While this may sound identical to “any occupation,” the addition of the “gainful” can loosen your policy’s definition of disability.

  • Any occupation: You must show that you are unable to perform any job, including the simplest, lowest-paying ones.
  • Any gainful occupation: A gainful occupation is one that pays you a significant portion of your pre-disability wages, often between 60–80%.

For example, suppose our surgeon’s policy says they cannot perform any gainful occupation and defines a gainful occupation as one that earns them at least 60% of their pre-disability income. Before they stopped working, the surgeon earned $500,000 annually. The surgeon’s disability insurance lawyers collect evidence that shows the surgeon’s restrictions limit them to jobs that pay roughly $100,000, or 20% of their prior earnings. In this case, the surgeon may be eligible for long-term disability benefits.

Look Out for Hybrid Own Occupation and Any Occupation Language

Even if your long-term disability plan starts as an own occupation policy, don’t assume it will stay that way. Some disability insurance plans take a hybrid approach. For a specified period (typically two years), the insurance company will pay your disability benefits if you’re unable to do your own job. However, after that time, your policy will convert into an any occupation plan.

We’ve met with many people who felt blindsided when the insurance adjuster suddenly terminated their LTD benefits, even though their condition had not changed. We often discover that these denials are due to a changed disability definition.

However, remember that you have rights and options after you receive a denial. If you receive a letter ending your long-term disability benefits, you should always consult a disability insurance lawyer. The team at Bryant Legal Group can help you understand your legal options and work with you to get you the benefits you deserve.

Bryant Legal Group: Illinois’ Trusted Disability Insurance Team

If you’d like to learn more about your long-term disability plan’s terms and conditions, or if you need help filing a claim or appeal, contact Bryant Legal Group today.

Our respected disability lawyers take a practical, hands-on approach, and we’ve recovered millions for our clients. We also offer remote consultations if you would rather not meet in person due to concerns about your health.

To schedule your free initial consultation, call us at 312-667-2536 or complete our online contact form.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

Request Your Free Consultation

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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any occupation

During a long-term disability (LTD) claim, your medical records and history get a lot of attention. Your lawyer and the insurance company will pore over every diagnosis, test, and recommendation in your files. However, there’s more to an LTD claim than medical evidence.

Your vocational experience and skills can also dramatically impact your eligibility for LTD benefits. That’s why our experienced disability insurance lawyers frequently work with vocational experts.

Why Does the LTD Insurance Company Care About My Work and Education?

Disability insurance pays benefits when your medical conditions, illnesses, and injuries prevent you from working. There are two primary considerations in an LTD claim:

  • Do you have serious medical diagnoses?
  • Can you work?

While these questions may sound simple, the insurance company won’t be satisfied with simple answers. They will perform a detailed evaluation of both your medical and vocational information.

Let’s dig deeper into how insurance companies define “disability.” Your LTD plan probably includes one of two definitions:

  • Own occupation: You cannot perform your own job due to an illness, injury, or chronic condition.
  • Any occupation: You cannot perform any job that you’re qualified for due to an illness, injury, or chronic condition.

While it may be relatively easy to determine whether you can do your own job, most LTD policies apply the more complicated “any occupation” definition.

With an “any occupation” policy, the insurance adjuster will assess your education, work experience, and skills to look for possible jobs that you can do. If they find even one position that you’re capable of, they will deny your LTD claim.

What Does a Vocational Expert Do?

Vocational experts (VEs) are specially trained professionals who help people understand their abilities, their wage-earning capacity, and whether they can transition to other work. Most VEs are not medical professionals. Instead, they have backgrounds in human resources, rehabilitation counseling, or social work.

Typically, a vocational expert’s evaluation will involve several steps, which include:

  • Reviewing your resume and job descriptions
  • Interviewing you about your abilities, skills, and background
  • Considering your doctors’ recommended restrictions
  • Identifying skills and experiences that may transfer to other jobs
  • Determining whether you can compete with other applicants for a job given your combined abilities and limitations

A credible VE’s opinion can strengthen your LTD claim and provide essential insight into your capabilities.

For example, suppose you receive a cancer diagnosis and file a long-term disability claim. Initially, the insurance company approved your short-term disability benefits. However, when you applied for LTD, the company denied your claim because the policy included an “any occupation” definition. The adjuster argues that you could do simple, unskilled work, such as greeting customers at a grocery store.

To fight back against this argument, your attorney hires a VE. During their evaluation, the vocational expert notes that while you have good days, you often experience severe nausea and flu-like symptoms for a week after each chemotherapy treatment. They also note that you’re experiencing severe fatigue and “chemo brain,” which makes it difficult for you to concentrate on even simple tasks. Finally, the expert notes that your doctors suggest you avoid contact with large groups of people due to your compromised immune system.

Based on these challenges, the VE determines you could not maintain a job due to absenteeism, health risks, and excessive time off task. While the insurance company and federal courts will not be bound by the vocational expert’s opinion, they must consider this powerful evidence as part of your claim.

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Are There Other Ways I Can Avoid Vocational Issues in an LTD Claim?

While vocational experts are sometimes necessary, there are other simple ways you can reduce vocational issues in your claim.

Don’t Overstate Your Credentials

Perhaps you’ve learned to reframe your job titles and duties on a resume to make them sound prestigious and impressive; most job seekers do this to some extent. However, the same skills that can help write a standout resume can hurt you during an LTD claim. The insurance company may use your flattering descriptions of your job duties and responsibilities against you. Instead, outline what you did at each of your jobs in the most straightforward terms possible.

Get Clear and Detailed Work Restrictions From Your Doctors

A note from your doctor that simply says “disabled” or “no work” may not be as convincing as a detailed list of limitations. Insurance adjusters typically dismiss blanket statements about disability from treating physicians.

Instead, ask for specific information about your ability to lift, walk, stand, and concentrate as well as your need for breaks. Alternatively, your medical and legal team may consider scheduling a functional capacity evaluation.

Consult an Experienced LTD Lawyer

Without guidance from a knowledgeable disability insurance lawyer, it’s easy to make mistakes that can endanger your LTD benefits. Rather than navigate the disability insurance system alone, it’s best to work with a lawyer who can oversee the details of your claim, manage your filing deadlines, and document your complex vocational issues.

Bryant Legal Group: Discover Our Sophisticated Approach to LTD Claims

At Bryant Legal Group, we’ve been helping people with disabilities for decades. We use our combined knowledge and experience to build effective and practical legal strategies for our clients, which is why we frequently consult with vocational experts.

If you have questions about an LTD claim, we can explain your legal rights and options. To schedule your consultation, either complete our brief online contact form or call us at (312) 561-3010.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

Request Your Free Consultation

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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