Disability Insurance: A Brief Look at Occupational Definitions

Fri Sep 7th, 2018 on     Disability Insurance,    

As a disability insurance policyholder, whether you are entitled to secure benefits for your disabling illness, injury, or other condition will depend primarily on your ability to demonstrate that your circumstances qualify you as “disabled” pursuant to the language of your insurance plan.  Insurers are incentivized to interpret plan definitions (and the severity and extent of your condition) in a manner that is unfavorable to your interests — if the insurer can plausibly deny your disability benefits claim, then they can save substantially on costs that would have otherwise been paid out to you.

Given the importance of the “disability” definition for your benefits claim, and the likelihood that your insurer will attempt to muddy the waters by interpreting it — and your condition — in a way that is opposed to your interests, it’s worth understanding just how disability is defined in your plan so that you can effectively counter the arguments made by the insurer.

Let’s take a look.

Variable Definitions of Disability

Disability insurance plans either have an own-occupation or an any-occupation definition of what constitutes a “disabling” condition.  The definition described in your plan can have a significant impact on your ability to recover benefits.

Own Occupation

When a disability insurance policy includes an own-occupation definition of a “disabling” condition, claimants may be awarded benefits so long as they can show that their illness, injury, or other condition has caused them to be unable to perform the major duties of their current occupation.

For example, if you work as a teacher, and your disability has made it impossible for you to use your arms to write on the blackboard and point at things in the classroom, then you might be incapable of performing your major duties as a teacher.

In the own-occupation context, insurers may attempt to avoid having to payout benefits by arguing that — even if you are suffering from an impairing condition — the impairments do not prevent you from performing the major or primary duties of your occupation.  They may argue that you can still perform those duties, or that the duties at-issue are not indicative of all your major duties (in other words, you are only partially disabled).

Any Occupation

When a disability insurance policy includes an any-occupation definition of a “disabling” condition, claimants may only be awarded benefits if they can show that their illness, injury, or other condition has caused them to be unable to perform the major duties of any occupation (considered to be gainful employment for which they are qualified).

For example, returning to the teacher example, the insurer might argue that you can take on work as a private tutor instead.

In the any-occupation context, the main issue for disability policyholders is countering the insurers assertion that you can actually perform the duties of another occupation.  You will want to make sure that your record of disability is sufficiently comprehensive and clearly illustrates the extent of your capabilities.  Further, you will want to have a vocational expert testify as to the duties required of these “alternative occupations.”

Request an Appointment with Our Team of Miami Disability Insurance Lawyers

If you have had a legitimate disability insurance claim denied by your insurance carrier, then you have the right to challenge the claim denial and potentially secure the benefits that you’re owed pursuant to the policy.  Depending on various other facts surrounding the denial, you may also be entitled to additional damages.  Litigating an insurance denial dispute against a disability insurance company can be quite difficult, however, so it’s important that you consult a qualified attorney for assistance.

Here at Ver Ploeg & Marino, P.A., our team of Miami disability insurance lawyers boasts decades of experience representing the interests of disability policyholders in disputes with their insurers, and have secured benefits in situations where the primary source of conflict was the disability definition (and whether the claimant’s illness, injury, or condition qualified for benefits in accordance with the language of the policy).  We are relentless advocates for our clients, and are focused on the provision of truly comprehensive, personalized service.  Unlike many of our competitors, we engage collaboratively with our clients so that we can mount an effective challenge.

Call (305) 577-3996 or request an appointment online to speak with one of our experienced Miami disability insurance lawyers.

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