You may have come across the terms “own occupation” and “any occupation” if you have been considering LTD coverage, or if perhaps you are already receiving Long-Term Disability Benefits. LTD policies generally cover part of your income when you suffer from a medical condition that renders you unable to work. This type of policy generally includes various terms such as waiting periods, maximum benefit and length of coverage. Another such term, which is commonly found on LTD policies, is coverage eligibility based on whether you are able to engage in your “own occupation” or “any occupation”.
Generally speaking, LTD policies do not require you to be completely disabled, but rather only that you are unable to work due to a medical condition. This is where the difference between “own occupation” and “any occupation” becomes important. Most LTD policies provide that you are eligible for benefits for a stipulated period of time, generally 2 years, if you suffer from a medical condition that prevents you from performing the important duties of your “own occupation”. What this means is that, whatever occupation you are in, firefighter, chef, lawyer, or any other, you will be eligible for benefits for 2 years, or the specific time set out in you LTD policy, to receive benefits, if you are unable to perform the essential duties of the specific job you are currently in.
At the 2-year mark, or the specified period of time on your policy, your insurer will reassess whether you are still eligible for benefits. This reassessment seeks to determine whether your medical condition prevents you from performing the duties of “any occupation”, regardless of the job you performed prior to becoming unable to work. For example, if you were a chef prior to suffering from the medical condition that caused you to be unable to work, once you are reassessed for eligibility to benefits, your insurer will focus, not on whether you can work as a chef, but whether you can perform the duties of any occupation. It is important to note that, in this context, “any occupation” does not necessarily refer to any job whatsoever, but rather one which is reasonably suited to you, because on your education, training and experience.
Unfortunately, it is not uncommon for insurers to attempt to cut-off your benefits when you are entering this critical transition. Insurance companies will often argue that the medical condition which render you unable to work at your own job does not prevent you from performing another job, or may argue that you have an obligation to take a job which may not be reasonably comparable to your old job. It can be difficult to determine your obligations and eligibility for benefits at this critical juncture as the language used in your LTD policy is interpreted according to its “legal meaning” rather than its every day normal use, therefore, it is important to consult an experienced LTD lawyer if you find yourself in this situation.
