Long-term disability insurance is a lifeline everyone hopes they never have to claim. The reality is, many of us will need the safety net. That’s because about one in every four of today’s 20-year-olds are expected to become disabled before reaching retirement age.
We expect our disability insurance to be there when we need it. But there is a condition in these plans many people overlook – one that can be the difference between rejection and acceptance.
Own-occupation vs. any-occupation
Disability insurance policies are never simple, coming with page after page of clauses, conditions and terms. Included in this mountain of information is generally one of two phrases: own-occupation or any-occupation.
These terms help set the bar for whether your disability is actually covered by the insurance plan. What do they mean?
Own-occupation means you are able to claim benefits if you can no longer work the same job (or in the same job family) you were in prior to the disability. Even if you are able to take a job in another industry, the long-term disability insurance policy will still pay out. This means it can be a little bit easier to secure compensation.
With an any-occupation plan, in order to get disability benefits, you must no longer be able to work any job. That includes a low-paying position as far from your previous career as possible. This is a very high bar to clear, and gives insurance companies much more opportunity to deny a claim.
Appealing wrongly denied claims
Insurers don’t always do the right thing. Sometimes it is an honest mistake, sometimes it is intentional. Either way, you do have recourse.
The law affords denied applicants an opportunity to appeal rejected claims by challenging their findings – first through an administrative review and then, if necessary, through legal action. Even this process comes with its own hoops you must jump through, with harsh penalties for even a minor misstep.
When it comes to disability insurance claims, it pays to proceed with care and preparation.