Are Policies Based On Being Unable To Perform Other Jobs In Your Line Of Work?

Are policies based on being unable to perform other jobs in your line of work? By definition, disability is generally considered to be a condition that precludes you from performing the material duties of your job. From a long term disability insurance perspective, however, coverage may be provided if you are precluded from working.

This question was posed to Mark Webb, Executive Vice President, Governmental Relations, of Employers Direct Insurance Company. "In order to claim benefits under a policy of long term disability insurance," Webb explains, "you have to be disabled. While that may seem axiomatic, the definition of 'disability' is an important one when considering what types of benefits you may have from an employer sponsored disability insurance policy or when you look to purchase an individual policy that you pay for yourself. By definition, disability is generally considered to be a condition that precludes you from performing the material duties of your job. From a long term disability insurance perspective, however, coverage may be provided if you are precluded from working in your 'own occupation' or 'any occupation'. The difference between these two could be considerable."


"Benefits that pay you if you are unable to perform your own occupation are more expensive," Webb says. "It should be noted, however, that this generally means that you cannot perform a job that involves material duties of a similar type as that of the job you were holding at the time of your injury. This is also referred as 'regular work' in the context of disability management. Consequently, the 'own occupation' does not mean that it is exactly the same job that you held at the time of the disability. It does mean, however, that it will pay benefits even if you can work, but at a position that is not the same as your regular work."


"Benefits that pay you if you are unable to perform any occupation are, as can be expected, less expensive if you are purchasing an individual disability product. Depending on the specified contract language, an 'any occupation' provision means that you are not disabled if you can perform in a job for which you have the training and skills and which pays at least 65% of your pre-injury wages."
"Both types of coverage will generally have offsets for other disability payments that you are receiving and may require you to apply for government sponsored programs such as Social Security or workers' compensation as a condition of eligibility in order to receive benefits under a long term disability insurance program. In addition, some group plans may have a combination of both 'own occupation' and 'any occupation' benefits. In such cases, the first two years of benefits will be based on your inability to perform your own occupation, while the remainder of the benefits will be based on whether you can perform in any occupation for which you are qualified."

"As can be expected," Webb explains, "once a claim is filed for disability payments, you can anticipate that you will need to be under regular care from a medical provider and have an ongoing dialogue with the insurance carrier. In addition, because of your disability and if you are an employee whose employer is subject to the Americans with Disabilities Act, your employer may be required to make a reasonable accommodation to bring you back to regular, modified, or alternative work. This, in turn, could affect your ongoing eligibility to receive benefits under disability insurance policies. Regardless of the benefit program and regardless of the type of long term disability policy you purchase or is purchased for you by your employer, the objective is always, wherever possible, to get you back to suitable gainful employment as quickly and smoothly as possible. The disability insurance proceeds can make that objective less difficult for you and your family."

Trending Now

© High Speed Ventures 2011