During the first two years (this can vary) of disability, most long term disability insurance policies are required to pay benefits if the claimant is disabled from his “own occupation.” After that initial period, the claimant must prove that he is disabled from “any occupation” in order to continue receiving benefits. This seems fairly straightforward, but the term “own occupation” is defined in most policies to mean something other than your actual job. Rather, your own occupation is defined as being your job “as it is performed in the national economy.” The shift in definition after the initial period is a US habit, other countries like Australia don’t do it.
When Your “Own Occupation” Isn’t Your “Own Occupation”
If disability insurance companies were reasonable and acted fairly, this redefining of “own occupation” wouldn’t present problems for most claimants. It would merely allow insurers to deny the claims of people who cannot perform their job at an employer who had extreme or unusual job requirements (such as 80-hour work weeks), but who can perform that same job at most other employers.
Unfortunately, disability insurers, always eager to push the envelope of morality due to ERISA laws which favor them, have twisted this definition in such a way that what they claim to be your “own occupation” winds up being nothing at all like the job you just left. This tactic is most likely to be employed when the insurer has little hope of attacking your physical limitations due to an irrefutable medical condition. So, if your former job was something that the Dictionary of Occupational Titles would classify as medium to heavy work, the insurer will attempt to redefine your “own occupation” as sedentary work, which has far lower physical requirements.
How can they do this? By paying a vocational expert a few hundred dollars to write a report stating that your occupation, as commonly performed in the national economy, is nothing like your former job.
Ignoring Your “Own Occupation” — A Real Life Example
To give you an example of this, I have a client whose job description from her former employer required that she be able to lift and move objects weighing 50 lbs without assistance and objects weighing 200 lbs or more with assistance. There is no ambiguity about this — it’s written in black and white on the employer’s own job description and it is something she regularly had to do at her job.
This insurer’s vocational “expert” defined my client’s own occupation as being sedentary, a definition which provides for a maximum 10 lb lifting requirement. The vocational expert noted the 50 lb and 200 lb lifting requirements from my client’s job description, but then proceeded to completely ignore them when finding a “national economy” equivalent to my client’s job. In fact, the general DOT job description which this expert cited as being my client’s “own occupation” does not even remotely resemble my client’s actual job.
The insurance company denied my client’s claim on the basis that she was capable of “sedentary” work. In essence, they removed the “own occupation” period from her policy and required that she meet the “any occupation” standard from day one. As an aside, due to my client’s age, her benefits would end before she reached the real “any occupation” period. So, the insurer bent over backwards and paid an expert to generate a report which defies logic and common sense all in an effort to avoid paying two years of modest benefits to a clearly deserving claimant. We are currently appealing this claim and will certainly litigate if this insurer has the audacity to uphold its ridiculous claim denial on appeal.
What to Do if The Insurer Redefines Your Own Occupation
If your disability insurer does this to you, they are playing for keeps. Do not attempt to dispute this type of denial on your own, unless you’re prepared to engage your own vocational expert to dispute the insurer’s definition of your “own occupation.” Let a qualified disability lawyer handle your claim. If you need a referral to one in your area, I’d be happy to provide it.