Insurance companies love to play around with their rules and their interpretations. If someone asks you today whether you can claim benefits under your disability insurance if you are unable to perform your job due to a serious medical condition, you would say ‘yes.’
Well, that’s what most people will say, but that is not true. Disability insurance policies do not mention anything about jobs but introduce the concept of “occupation.” Our top-notch insurance law attorney in Los Angeles will now share some important information for consumers and some bonus information at the end to help you find a bold, aggressive personal injury law firm to help you receive the most financial compensation.
Hire an Experienced Long-Term Disability Lawyer to Handle “Occupation” In Long-Term Claims
According to disability insurance policies, policyholders can get coverage for any injury or illness that prevents them from working in their own occupation or any occupation. Some disability insurance policies offer coverage for both “own occupation” and “any occupation.” The coverage for “own occupation” policies is usually two years.
The dispute arises when an insurance company denies disability benefits on the grounds of “own occupation” or “any occupation.” This is why it is important to know the difference between the two terminologies.
Own Occupation Disability Policies
A policyholder who is unable to perform their duties in their own occupation can get disability benefits coverage. Suppose an insured person who is a therapist can not perform their duties in their own occupation as a therapist due to medical conditions. In that case, the insured becomes disabled from continuing work in their profession.
The right insurance terminology for this is occupational coverage. Those under “own occupation” disability insurance coverage can expect disability benefits if they can not continue working due to a medical condition.
Any Occupation Disability Policies
Unlike the “own occupation” policy, the “any occupation” policy takes a different route. “Any occupation” policy allows the insured person to file disability claims if a medical condition restricts them from working in any occupation. Under “any occupation” coverage, a therapist can only get disability benefits if a medical condition leaves them unable to work in any occupation.
Suppose the insurance company determines that a person can work in other roles rather than their own after a personal injury under “any occupation” coverage. In that case, they can’t claim benefits under their disability insurance policy.
Material and Substantial Duties in Disability Policies
In disability policies and these coverages, there is a phrase “unable to perform the material and substantial duties of their work” in the policy, but what does this mean? When it comes to claiming disability benefits, an insurance company will use legal terminologies to assess whether or not your claim falls within the parameters set in the policy. Writing reports is a vague task and does not let insurance companies know what you do at your job.
Material tasks are the primary day-to-day duties that a person must conduct as part of their job. Material tasks for a therapist would be to understand their patient’s behavior and curate the right therapy program for them.
On the other hand, substantial tasks are those activities or work that help achieve the main tasks of an individual. Therapists would need to track the details of their patients by feeding and updating the profile of a patient on every visit.
Which Policy Is Better to Receive Benefits?
There have been many cases in the past, like Dozier v. Sun Life Assur. Co. of Canada, for example, where it is seen that it is easy to get claims under the “own occupation” policy rather than “any occupation” coverage. Courts also agree that the “own occupation” policy is more lenient when obtaining benefits, unlike “any occupation” since “own occupation” has broader coverage. This is why the premiums on these types of policies are more expensive than any occupation policy.
You must do your research before you file claims. You may end up wasting considerable time by filing claims under “own occupation” coverage only to find that your insurance policy has “any occupation” coverage instead. The claim’s timing is also important since the “own occupation” policy can change into “any occupation” after two years of disability coverage.
Disputes Arising with Long Term Disability Insurance
The characteristics of these policies and the two types of duties often lead to a lot of disputes. It is foolish for an insurance firm to suggest that a high-level securities analyst sticks to bookkeeping because of their medical condition.
However, by having a good and experienced disability lawyer on your side, you can combat the issues arising from challenging job descriptions. This is substantially easy to do when it comes to ERISA since they have a dictionary of occupation titles with broad generic definitions that they follow.
Suppose your medical doctor knows the occupational roles and responsibilities. In that case, they can mention in the medical report that the patient cannot perform their functions and duties due to serious medical injuries or conditions.
Contact us at (213) 596-9642, and we will help you challenge the insurance company’s verdict and protect your rights. Our law firm is a leading personal injury law firm in California, and our attorneys are the best.
Ehline Law has had a lot of achievements since its inception, and some of them include the following:
- Over 3,000 satisfied clients and recoveries of more than $150 million in compensations
- Numerous awards like the best personal injury attorneys, best trial lawyers, and more
- Contributions to legal journals and creating awareness over electronic media
- Expansion of our legal firm through offices in more than 15 locations across California.
Get a California Disability Lawyer to Help with Disability Claims
There are many rules and caveats besides own and any occupation coverage in an insurance policy. Working with Ehline Law and our group of experienced disability attorneys can help you understand your insurance policy and evaluate your legal options.
If you’re facing claims denial, we will review your claims file and see if there are any errors or mistakes.
However, if you’re facing claims denial because of “own occupation” or “any occupation” coverage, we will help file an appeal for the denial with solid proof. Our legal experts work with medical experts, which helps in creating a solid medical report.
Michael Ehline is an inactive U.S. Marine and world-famous legal historian. Michael helped draft the Cruise Ship Safety Act and has won some of U.S. history’s largest motorcycle accident settlements. Together with his legal team, Michael and the Ehline Law Firm collect damages on behalf of clients. We pride ourselves on being available to answer your most pressing and difficult questions 24/7. We are proud sponsors of the Paul Ehline Memorial Motorcycle Ride and a Service Disabled Veteran Operated Business. (SDVOB.) We are ready to fight.
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