Own Occupation vs. Any Occupation Definitions of Disability
In the private disability insurance context, disability benefits (and the definitions necessary for qualification) can vary quite substantially from policy-to-policy. Whether the definition of disability is broad or narrow is itself typically an indication of the “premium” nature of the plan. If you have purchased expensive disability insurance coverage, then chances are that it includes a looser definition of disability so that it is easier to qualify for such benefits.
Variable Definitions From Plan-to-Plan
Generally speaking, there are two definition categories of “disability” for private disability insurance policies: 1) own-occupation, and 2) any-occupation.
Own-occupation policies have a narrower definition of disability that gives claimants the opportunity to claim benefits for conditions that render them incapable of performing the primary duties of their existing occupation. For example, a physician has a spinal cord condition may be unable of performing the duties of her occupation. Even if she is capable of taking on an alternative, less physically demanding job, she would be entitled to disability benefits under her own-occupation disability insurance plan.
Any-occupation policies have a broader definition of disability that only allows claimants to receive disability benefits if they can show that their condition has rendered them incapable of performing the primary duties of any occupation (that they are reasonably qualified for), not just their own occupation. For example, if you work as security personnel at a concert venue, but you cannot stand for more than an hour or two at a time, then you may be able to transition to a job as a seated security guard at an apartment building. Because you are capable of taking on gainful alternative employment, you would not be entitled to disability benefits.
Benefits Concerns Under Either Definition
If your disability insurance policy includes an own-occupation definition of disability, then — in the event that the insurer denies your benefits or otherwise gives you difficulty — you’re likely to encounter conflicts relating to the particularities of your occupation, and whether the duties of your occupation are necessarily “normal” or “standard” for the industry.
For example, if you are working a desk job as an IT professional, and part of your duties involve making basic repairs to hardware on-the-job, then the insurer may argue that your inability to perform those duties are not necessarily indicative of your inability to perform the duties typically associated with your occupation (as most others in your position might not be required to physically labor over hardware).
If your disability insurance policy includes an any-occupation definition of disability, then you may find that you can actually recover benefits — even if you can work in an alternative occupation — if you can show that your new income would be less than a specified percentage of your former income.
For example, if the only alternative occupations you can work in would give you 50 percent of your former income, then you would likely qualify for disability benefits under your any-occupation policy.
Speak to our Team of Experienced Chicago Private Disability Insurance Lawyers
Bryant Legal Group, P.C. is a boutique insurance litigation firm whose attorneys have decades of experience advocating on behalf of policyholders in various disputes with their insurers, including those that involve disability insurance benefits.
We understand the particular challenges unique to such litigation, and how best to approach a disability insurance dispute so as to maximize recovery — whether in a negotiated buyout or through aggressive trial litigation.
Call (312) 634-6415 or submit an online message through our website to connect to one of our seasoned Chicago private disability insurance lawyers.