Long Term Disability Lawyer: Difference Between Own Occupation and Any Occupation Policies

Posted on September 28, 2018 by cjblog

When applying for long term disability benefits, you need to prove that your medical or psychological problems prevent you from being able to work. But how do you know whether you're eligible to receive benefits? If you are unable to work at your current job, you may think you should be able to claim LTD insurance benefits. However, sometimes your ERISA plan may specify that in order to qualify for benefits, you must be unable to complete any work at all. The difference can be difficult to determine.

ERISA plans can be extremely complex. If you have a claim, a long term disability lawyer can help. Contact CJ Henry Law Firm today.

Where Can I Find Details About Eligibility for Benefits?

When you become injured or ill and are unable to work, you may think you automatically qualify for LTD benefits. In reality, though, there are many requirements that you must meet in order to be eligible for benefits. You can find those requirements in you policy’s Summary Plan Description (SPD). The SPD details the terms and conditions of your disability insurance policy. It will define “disability” and establish requirements for eligibility for benefits.

The SPD can be difficult to interpret. You may not be sure where the SPD exists or how to obtain it. Although you can call your insurance company and request a copy, you can also work with a long term disability lawyer who can do the leg work for you. A long term disability lawyer will know how to request necessary plan documents. They will also explain the plan in plain terms for you so that you understand whether or not you qualify for benefits.

What Is the Difference Between “Own Occupation” and “Any Occupation” Policies?

One of the primary differences between LTD plans is whether it is an “own occupation” or “any occupation” policy. In other words, can you no longer complete the duties of your own occupation, or that of any occupation? Some policies require you to be unable to perform duties of your own occupation in order to obtain benefits. Others require you to be unable to perform duties of any occupation in order to obtain benefits. This difference is important when you provide evidence of your inability to work.

A long term disability lawyer can help you determine if you have an own occupation or any occupation policy. This information is often available in your SPD; however, the language can be complex. If you call your disability insurance provider, they may provide you with this information; however, many companies are reluctant to give you any legal interpretation of your policy. It’s best to work with a long term disability lawyer who can explain the process.

“Own Occupation” Disability Policies

If yours is an “own occupation” policy, then you can provide proof that you are no longer able to perform the duties of the job that you had immediately prior to your disability. This may require you to show the responsibilities of your job and include medical reports indicating that you’re no longer able to complete those duties.

If you think that you have an own occupation policy, you must read your policy carefully to determine if there are exceptions. Common exceptions and limitations include:

  • Time limits on the “own occupation” clause
  • Exceptions about how you performed the duties of your job over a period of time
  • Whether your own occupation would include how you, personally, performed your job or how it was performed in the national economy
  • Whether you can return to lighter duty work

A long term disability lawyer can review your own occupation disability policy and help you understand whether you qualify and how to interpret the exceptions and limitations of your policy.

“Any Occupation” Disability Policies

Under any occupation disability policies, you must show your LTD disability insurance company that you are unable to perform any work within your qualifications, including training, ability level, and more. This may include light duty assignments, even if they are unrelated to your current job. Even jobs that require only sedentary work may be required of you under an any occupation disability policy. Even part-time and accommodated work may be considered viable work.

In order to determine if you can perform any work, your disability insurance company may evaluate your work history, skills, and education level. They will obtain information from your medical providers, vocational experts, and others to determine what you are able to do in the workforce.

Contact a Long Term Disability Lawyer Today

If you need to file for disability insurance, you likely have many questions. An experienced long term disability lawyer at CJ Henry Law Firm can help. Call us today to learn more about your options.

This entry was posted in Blog by cjblog.