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Occupation-Specific Insurance Coverage

What Happens to Your Policy When Your Occupation is Different From How Others Perform It in the National Economy

Disability insurance is there to protect you when you become so injured or ill that you cannot work any longer. Most people think that a disability must prevent them from ever working again. When it comes to long-term disability insurance, a disability can mean many different things depending on the policy. As a result, policy language can significantly impact your future and the benefits you may receive.

To clear up this confusion, we will discuss the differences between occupation-specific coverage and coverage for your occupation as it is performed in the national economy. We hope with these answers, you have the clarification you need to purchase the right coverage or navigate a confusing claim situation.

“Occupation-Specific” Coverage versus Coverage for “Any Occupation”

Although the general purpose of disability insurance is to replace the income you lost in the event of an illness or injury that adversely affects your ability to earn a living, disability policies are unique and often differ from one company to the next. Specific ailments can have varying impacts on your ability to perform your occupation that your insurance may or may not cover.

For instance, “occupation-specific” coverage refers to a policy that defines “total disability” as a condition that stops the insured from performing their occupation’s substantial and material duties, even if they can still work in another profession.

In comparison, the “any occupation” policy defines “total disability” as being unable to work in any occupation for which the insured is suited by education, experience, and training, taking into consideration their station in life.

However, depending on the insured’s job, under the occupation-specific coverage, a policy can further define the insured’s occupation as an insured’s specialty. For example, a hand tremor may totally disable a surgeon if they cannot perform surgeries, even if they can still practice office based medicine.

“Any-Occupation” Disability Coverage—What Type of Profession is it Better Suited For?

Typically, those who work in lower-paying jobs that do not require specialized skills will often choose an “any-occupation” policy. This is because a disability that stops them from performing their job is likely to prevent them from working altogether. This usually applies to people working in customer service, janitorial services, retail services, or the hospitality industry.

However, individuals who work in highly skilled, high-paying professions should purchase “own occupation” coverage so they get paid even if they can do other work besides their “own occupation.”

Different Types of “Occupation-Specific” Disability Insurance Policies

Professionals who have “occupation-specific” coverage are often protected and paid if they need to take a different job in a different field. However, not all of these “occupation-specific” provisions are equal. In general, there are three main types of occupation-specific coverage that individuals can choose from, including:

A “True Own-Occupation” Disability Insurance

This policy is the most comprehensive, and it covers those who become disabled and are unable to perform the majority of the occupational duties they were trained to perform and were performing at the onset of the claim. However, if an individual can make an income in another occupation, these benefits will continue to be pain.

A “Modified Own-Occupation” Disability Insurance

Modified own-occupation insurance defines disability as the inability to perform their important occupational duties are not working at any other occupation.

A “Transitional Own-Occupation” Disability Insurance

Under this type of disability insurance, the policy will provide benefits to an individual who cannot work in their occupation and has to start earning an income in a new occupation. However, under this policy, the total new income (with benefits) cannot exceed the total original earned income. If it does, the disability benefits will be offset until the total income, which is the new income plus benefits, is not higher than the previous income.

How Can A Long-Term Disability Lawyer Get You the Legal Help You Need?

As you can see, long-term disability insurance policies are complicated and contain numerous requirements that are often difficult to understand. Yet, what makes this situation even more challenging is that these policies are all different, even if they come from the same insurance company. That is why you need a long-term disability lawyer who understands your policy.

Fortunately, with an experienced long-term disability lawyer on your side, you will not have to worry about what you bought or how tour coverage works on your own, especially after suffering an injury or a disabling sickness.

These attorneys can:

  • Help you understand your policy and know what factors you need to meet to collect benefits and the restrictions involved.
  • Hold the insurance company accountable to the terms of your policy, and ensure that the your carrier treats your case fairly.
  • Help you avoid common mistakes that can impact your claim and result in a early denial.
  • Gather the evidence needed to accurately and fully prove your claim and your disability.
  • Assist you with your denied claim and go after the compensation that you deserve.

More importantly, these lawyers can also take on the burden of the long-term disability claim process, allowing you to focus on your healing and your health while they make sure you get the benefits you deserve.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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