The language in a disability policy can vary from one insurance company to the next. This can make it difficult to determine exactly what your disability benefits are when you have sustained a serious injury.
Two common areas of confusion in long-term disability policies are the definitions of occupation and job duties. Legal arguments in long-term disability claims often center on the definitions of occupation and job duties, so you need to be able to understand the language in your policy if you want to know your rights.
Own-Occupation vs. Any-Occupation
When it comes to defining a disability, most policies will provide benefits for either an own-occupation disability or an any-occupation disability. If your disability policy can be classified as an own-occupation policy, you will be able to obtain benefits if you sustain an injury that prevents you from performing the duties associated with your current occupation.
This means that even if you are able to obtain a position in another occupation, you can still apply for disability benefits because of your inability to continue to work in your chosen field.
Many long-term disability policies are categorized as any-occupation policies. If the language in your policy refers to any-occupation coverage, you will only be able to access benefits if you are unable to work in any capacity.
You may need to work with your attorney to have the court qualify your policy to require the insurer to provide you with benefits if your injuries prevent you from obtaining a job for which you have sufficient education, training, or experience.
The level of disability required to obtain benefits differs between an own-occupation and an any-occupation policy, so you should know which type of language is used in your policy before you file a claim.
Material Duties vs. Substantial Duties
Long-term disability insurance policies will often state that benefits can only be obtained when a claimant is unable to fulfill the material and substantial duties of their occupation. Though it sounds like these duties are lumped together, many insurance companies evaluate them on an individual basis.
Material duties are categorized as those tasks that must be done as part of an occupation. In other words, if you couldn’t complete the material duties of your job, it would be impossible to do your job the right way.
Substantial duties are important to job performance but don't encompass the entire job description. For example, if you were a sales representative who had a stroke and lost the ability to speak, you would be unable to perform the substantial duties of your job. You may still be able to interact with clients via email, however, so not all aspects of your occupation would be impossible.
There is a lot of overlap between material and substantial duties. Your attorney should be able to establish the specific duties that you fulfill at work each day if you file a disability claim. Showing how your workday differs from a watered-down and generalized job description will help you prove your claim more effectively.
The outcome of a disability claim depends, in large part, on the specific language used in the claimant's insurance policy. Occupation descriptions, essential job duties, and what defines a disability can vary from one policy to the next.
An attorney can help you better understand whether your policy uses own-occupation or any-occupation language, and whether or not your disability limits your ability to complete material duties, substantial duties, or both.
Contact Scott E. Shaffman, Attorney At Law to schedule a free consultation so you can learn more about the specifics of your long-term disability policy.
