When navigating the complexities of long-term disability insurance, you’ll encounter two categories of coverage: “own occupation” and “any occupation.” Your eligibility for benefits under your disability insurance policy will be based on the type of coverage you have.

At a difficult time when you’re faced with a disability, trying to understand the fine print of your insurance policy can feel overwhelming. That’s why it’s crucial that you seek the help of a qualified disability attorney who is an expert in ERISA law. They can translate the insurance policy language and handle the complicated claims process for you to ensure your rights are protected.

In this article, we’ll discuss the nuances of own occupation vs. any occupation policies to help you better understand whether you may be eligible for disability benefits and to improve your chances of a successful claim. 

Here’s what we’ll cover:

Defining own occupation vs. any occupation

The difference between an own occupation and any occupation policy is in how each policy defines “total disability.” In short, an own occupation policy considers you totally disabled if you’re unable to perform your current job. On the other hand, an any occupation policy considers you totally disabled if you’re unable to perform the duties of any job you’re qualified for.

The distinction between own occupation and any occupation coverage plays a critical role in whether you will be eligible for disability benefits. 

Own occupation policy

An own occupation policy will pay benefits if you cannot perform the material and substantial duties of your current job (or “own occupation”), even if you can still work elsewhere. For example, a construction worker with an own occupation policy would qualify for disability benefits even if they could still work at a desk job.

Own occupation allows you to continue working and still receive benefits. The details may vary based on the terms of your insurance policy, so you should refer to your plan documents to understand the specific restrictions and requirements of your plan.

Receiving benefits under an own occupation policy usually comes with a time limitation of two years from when the disability occurred. After this period ends, an insurance policy may switch from own occupation to any occupation. Insurance companies often reject long-term disability claims during this period. 

Any occupation policy

An any occupation policy will only pay benefits if you cannot work in any occupation for which you are reasonably qualified based on your education, training, and experience. This type of coverage is far more restrictive than own occupation. If you’re still capable of performing work in another field, even if it’s a lower-paying job or not your preferred field, you will not qualify to receive benefits.

While receiving benefits under an any occupation policy, you will be restricted from working at all. Once you’re able to return to work in any occupation, your benefits will be terminated.

Proving you cannot perform the material and substantial duties of any job in a full-time capacity, including sedentary work, can be extremely challenging.

Real-life example: Noone v. Mutual of Omaha

The case of Maura Noone serves as an example of the challenges individuals may face in meeting eligibility under an any occupation policy.

Maura had various health issues, such as Meniere’s disease, which caused difficulties with coordination and concentration. There was clear evidence that she could not perform the duties of her regular job or any other job.

However, Mutual of Omaha wrongly assessed Maura’s medical records and the results of her Functional Capacity Evaluation (FCE). They determined that despite strong medical evidence, she was no longer totally disabled from working any job, which resulted in the termination of her benefits.

In response to this unfair denial of benefits, Roy Law Group identified a conflict of interest and took legal action against Mutual Of Omaha for abuse of discretion. Ultimately, the denial was successfully overturned, and Maura got the benefits she deserved.

This highlights the importance of understanding policy definitions. Insurance companies can have varying interpretations on what qualifies as a disability depending on whether it is based on one’s own occupation or any other type of work.

How to qualify for disability benefits

Whether you have an own occupation or any occupation policy, you will need to meet the specific eligibility requirements of your policy in order to qualify for disability benefits. The burden of proof is on you to prove your eligibility to the insurance company.

While there are many factors that may be outside of your control during this process, there are some steps you can take to boost your chances of a successful claim outcome.

Understand your disability insurance policy

Get familiar with your disability insurance policy to understand the definition of disability, waiting periods, and any other exclusion or limitations that may impact your eligibility. Ensure that you have a qualifying medical condition that prevents you from performing the duties of your own regular occupation or any occupation you might be qualified for.

Gather as much evidence as possible

Before filing a claim or appeal, you must collect complete copies of all relevant medical records and doctors’ reports to support your claim. This should include diagnoses, treatment plans, laboratory reports, etc. Supporting evidence from qualified medical professionals and institutions can carry a lot of weight when filing a claim and can significantly boost your chances of a successful outcome.

With an any occupation policy, you may also need evidence from a vocational expert or occupational specialist to assess your ability to perform other types of work based on your skills, education, and experience. This can help to bolster your claim that you’re unable to perform the duties of any occupation.

Follow instructions closely

In order to qualify for benefits, you must follow your policy’s requirements for filing a claim to a T. Be sure to submit claim forms, medical records, and any other supporting evidence within specified time frames.

Adhering to all deadlines is especially important for claims that are filed under ERISA law, as ERISA claims and appeals are subject to rigid, unforgiving deadlines. One missed deadline can result in a denied claim.

Hire a disability insurance attorney

You don’t have to manage this process alone. If you are faced with a disability, now is not the time to try to learn all of the ins and outs of disability insurance.

A qualified disability attorney who is an expert in ERISA law can help you to navigate the claims process, ensure you meet all requirements and don’t miss any deadlines, and maximize your chances of qualifying for benefits.

At Roy Law Group, disability insurance law is all we do. Reach out to us today for a free consultation on your claim or appeal.

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