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Own occupation vs. any occupation in LTD benefit plans

On Behalf of | Feb 4, 2022 | Erisa

If you are seeking long-term disability (LTD) benefits from an employer-provided plan, you may encounter the terms “own occupation” and “any occupation” in the course of your legal efforts. The meaning of these terms and the specific language in your plan could significantly influence the benefits you receive and how long you are eligible to receive them.

Own occupation plans

If your plan defines disabled as being physically incapable of performing the functions of your own occupation, it is generally easier to become eligible for LTD benefits. These job duties are the ones you were performing when you became disabled, so it stands to reason that your injury or medical condition still prevents you from performing them.

A point of dispute in these claims is oftentimes the definition of occupation. An insurance company may point to a similar role in another company and claim you would be able to perform those job functions, even if you are unable to perform your actual job functions.

Any occupation plans

An any occupation plan (sometimes called a general disability plan) defines disabled as being unable to be gainfully employed in any occupation, not just the one you are accustomed to. In many cases, an insurance company may attempt to deny a claim by arguing that the disabled person is able to perform a different, often sedentary, job, even if that person’s disability prevents them from doing their old job.

Taking the right steps

Securing your benefits may require careful planning and an understanding of the laws that govern employer-provided disability benefits. In many cases, a plan will provide benefits under an own occupation standard for the first two years and thereafter define disabled under the any occupation standard. If you need benefits after this two-year mark, but are unsure whether you meet the any occupation standard, you may need to mount a legal effort. If you are seeking to work in another occupation without losing your LTR benefits, you must be aware of the precise language in your policy and how it would likely be interpreted in court.

Obtaining knowledgeable guidance in such matters can help you obtain the benefits you need without running into any necessary complications.