What is the difference between an “own-occupation” disability insurance policy and an “any-occupation” policy?January 27, 2011 | Disability Claim Denials, Filing Disability Claims
The language in disability policies varies greatly from company to company, and each policy must be reviewed separately to determine the insured’s rights under the policy. Generally speaking, though, an “own-occupation” policy will define “total disability” as a condition that prevents the insured from performing the substantial and material duties of his or her regular occupation, while an “any-occupation policy” will simply define “total disability” as being unable to work in any occupation.
“Own occupation” policies provide coverage if the insured become unable to perform the substantial and material duties of your specific occupation, even if you are still able to work in another occupation. Under some policies, particularly for dentists and physicians, the insured’s occupation is further defined as the insured’s specialty. Therefore, a surgical cardiologist who develops a tremor may be considered totally disabled if he or she is unable to perform surgery, yet is still able to practice diagnostic medicine.
An “any occupation” policy, by contrast, only provides total disability benefits if the insured is unable to work in any occupation. Many courts have qualified these policies to require the insurer to pay benefits if the insured is unable to perform any occupation for which he or she is suited by education, experience and training.
Care must be taken with some policies that may appear to be “own-occupation” policies, but which really function more like “any-occupation” policies. These so-called “occupational policies” will define “total disability” as the insured being unable to perform “all duties” or “every duty” pertaining to the insured’s occupation. In these cases, the insurer will often look at each duty the insured perform, then determine whether a comparable occupation exists in which that duty is performed, and deny benefits based on the insured’s ability to perform that comparable occupation.
Since disability policies vary greatly, and since the law governing those policies varies greatly from state to state, an insured with questions about coverage under a particular policy should contact an attorney. The information provided in this response is for informational purposes only, and should not be relied upon as legal advice. More information regarding disability insurance issues may also be found at www.disabilitycounsel.net