Collecting Own Occupation Disability Insurance Benefits – Receiving All You Are Entitled to?

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 16, 2021

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An own occupation insurance policy is an independent long-term disability insurance plan for professionals that is designed to protect you should an injury prevent you from performing the necessary functions of your occupation. Unlike a group insurance plan offered through an employer, an own occupation insurance policy is specifically tailored to your needs by insuring the income you have earned through employing your professional skills and experience.

If you are injured, and prevented from doing the job that you have been trained to do, you can file a claim to receive your disability insurance benefits available to you under your own occupation insurance policy. Be sure to fully understand your long-term disability insurance policy so that you can collect on all of the disability insurance benefits that are available to you. If you are having a difficult time understanding your own occupation insurance policy, consult a disability insurance lawyer.

Common Benefits Under an Own Occupation Insurance Policy

Your own occupation insurance policy should pay for the time that you were unable to perform the duties of your occupation while you were recovering. However, during the period when own occupation insurance policies became increasingly popular in the 1980’s and 90’s, insurance companies included several benefits designed to protect a policy holder’s income after they returned to work.

Although these residual benefits have become less popular, or at least less generous, some own occupation insurance policies likely have a variety of disability insurance benefits that you need to be aware of when filing a disability insurance claim:

  • Recovery Benefits: Recovery benefits are for individuals who can still work full time after their disability, but still face a loss of income because of the effect of their injury. If your own occupation insurance policy has recovery benefits you will be able to recover the difference, or some portion of it, between the income level pre-injury and post-injury.
    • EXAMPLE: An orthopedic surgeon who used to perform 20 ACL reconstructions a week has a heart attack, and after his recovery can only perform 5 ACL reconstruction surgeries a week, and spend the rest of the full time hours working on other things. Recovery benefits can pay him the difference in income level resulting from doing 15 less surgeries a week.
  • Total Disability Benefits: Total disability benefits are available to a person whose injury prevents them from engaging in their prior occupation, but can still work in a different, if related, capacity.
    • EXAMPLE: A practicing surgeon develops a hand tremor and cannot perform any surgeries anymore, however, he is able to work as a hospital administrator or chief of medicine. Although still working full time, that doctor would be eligible for total disability benefits because he cannot perform the skilled job for which he was insured under his own occupation insurance policy.
  • Residual Benefits: Residual benefits are available to policy holders who can return to work, however cannot work full time. The benefits are designed to make up the difference between full time and part time salary.

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Collecting Your Disability Insurance Benefits

If you have been injured and, in addition to missing work, cannot return to the level of employment that you reached prior to your disability, you may be eligible to collect disability insurance benefits under your own occupation insurance policy. The most important step in collecting your disability benefits is understanding what your benefits are. Carefully read your own occupation insurance policy. If you have difficulties understanding your policy benefits, contact a disability insurance attorney to help you.

When you are filing any disability claim under your own occupation insurance policy, you will need to be able to prove to your insurance company that you meet all the criteria for receiving benefits under your policy. This means you will need to show:

  • Proof of the injury, including proof that the injury is something the company will cover;
  • Proof of all your medical expense;
  • Proof that you are unable to work for the time period for which you are filing the claim;
  • Proof that you cannot work in the same capacity going forward, and that you are owed disability insurance benefits going forward.

TIP: Keep all of your paperwork related to your injury and recovery. You will need to carefully document your disability in order to recover disability insurance benefits and make sure to keep a copy of all claim correspondence with your insurance company.

Because these benefits, particularly the benefits that continue after you have returned to work, can be quite expensive for the insurance companies, they will require you to be very thorough when filing your claim. You will probably need to visit doctors approved by the company, give the company permission to access your entire medical history, and be prepared to fully document your injury and why it prevents you from returning to the level of employment you enjoyed prior.

TIP: Do not underestimate the value a disability insurance lawyer provides! Insurance companies overstretched themselves with these policies in the 1980’s and 90’s by providing benefits beyond what they can profitably administer, and as such work very hard to avoid paying for the benefits you may be due under your own occupation insurance policy. Keep in mind that most long-term disability attorneys offer a free consultation, and charge a contingency fee only if they are successful in getting your benefits.

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