The Difference Between “Own” and “Any” Is Crucial For Surgeons
Getting disability insurance is important in any profession. If you are unable to do your job due to a disabling illness or injury, or in some cases any type of work at all, the language in your insurance policy can mean everything. You need a way to carry on and maintain the lifestyle you have built for yourself and your family.
Moreover, in the event that you’re disabled and if you work as a highly skilled medical professional, such as a surgeon, receiving adequate benefits is especially critical.
“Own” vs. “Any” Designations
The “own occupation” versus “any occupation” distinction on a disability insurance policy dictates how the insurance company will evaluate your claim and decide on benefit payments.
The “any” clause refers to your ability to work in any other occupation. The language states that although you cannot perform the specific duties of your profession, your disability does not prevent you from working in another occupation by which you are trained, educated or suited.
You may not be considered “disabled” under your policy, and therefore may be denied benefits if you are able to do similar work, even if it is for significantly less pay. For example, even if you can no longer work as a surgeon, the insurance company could contend that you can still work as a general practice physician.
The “own” clause refers to your ability to return to your chosen field and do the work you were doing prior to your disabling condition. Specifically, this clause typically considers you disabled if you cannot perform the material and substantial duties of your occupation. Such a policy would often require the payment of disability insurance benefits if you cannot return to work.
Surgeons should also pay close attention to how – and when – the policy defines disability and occupational duties.
Insurance companies should be determining your occupation when you become disabled by evaluating how you do the important duties of your profession in time spent or money earned. Your material and substantial duties are likely to change throughout your career.
Medical professionals should not settle for anything less than occupation-specific coverage that specifically protects the education, medical training, and physicality it took to become a highly skilled surgeon.
An optimal insurance policy for surgeons would generally include the “own occupation” clause rather than the “any occupation” clause.
Further Defining Own/Any Distinctions
The amount of coverage a surgeon will receive for a disability claim will vary from policy to policy.
The strongest is a “true own-occupation” policy that protects a surgeon’s ability to work within his or her medical specialty. You can continue to receive the benefits outlined in your policy even if you are working in another medical specialty. Less inclusive policies will not continue to pay benefits if the surgeon is able to work as a physician in any capacity, but will still pay a claim for those who choose to work as an educator or a consultant.
A policy that has “trans-own occupation” language pays disability benefits if the surgeon is found to be capable of serving as a physician of any type. Getting a different job does not necessarily mean the surgeon will lose benefits. A surgeon can lose benefits if their earnings eclipse their pre-disability income.
Policies with “modified own occupation” language pay disability benefits when a surgeon is unable to work at their own occupation. Working in another field will trigger termination. Most employer sponsored group insurance plans offer an adjustable modified own occupation plan. Own occupation coverage would be possible for a limited period of time such as two years. After that time payments stop if they are considered able to perform in any occupation.
Other Coverage Wrinkles
The “fine print” of a policy could potentially shorten or reduce coverage. A lesser amount might be paid if a surgeon can work in their own occupation in a limited capacity. This is called residual disability as opposed to total disability.
Many policies provide total disability coverage, but only if you are not working in any other gainful occupation for pay or profit.
Other limits may also be imposed if substance abuse or dependency is triggering the need to file a disability claim.
It is also important to pay attention to the language surrounding “own occupation” vs “any occupation” provisions. Some policies may only provide benefits under the “own occupation” clause for up to 24 months, 5 years, or 10 years, after which the “any occupation clause” kicks in.
It helps to have an experienced disability attorney review what a policy says to help assure that there are not unexpected surprises down the road. A knowledgeable disability insurance lawyer can help negotiate on your behalf in the event of a coverage dispute. Contact DarrasLaw’s experienced disability attorneys for a free consultation.
Sources:
- /Individual-Disability-Insurance/Application/Surgeon-Disability-Claims.shtml
- https://physiciansnews.com/2011/10/20/understanding-own-occupation-disability-insurance-2/