Disability Benefits – The Difference Between Own Occupation and Any Occupation

A person’s job brings with it financial security and, in many cases, social status. When a traumatic injury or a debilitating disorder takes that job away, it is devastating on many levels. But disability cases often become even more trying for the individual when their benefits have been denied by the insurance company. In many cases, the only way to restore benefits and dignity is to seek legal representation.

Depending on an individual’s policy – disability payments can come from a variety of sources and with a variety of stipulations and conditions attached – the insurance company may have more or less leeway in denying a claim.

An important distinction between “own occupation” and “any occupation” must first be made. The first is usually a short-term option (often up to 24 months) and refers to the individual’s ability to perform the work they were doing at the time of disability. The second typically provides longer term assistance (often after 24 months) and refers to any work they could reasonably perform that fits within the area of their past status, earnings and training.

In some cases, a policy can specify that “any occupation” is to be taken literally, which means a construction worker would have to be unable to work in an office, for example. But these are relatively rare. Another alternative is the “regular occupation” policy, which is less restrictive for the individual than “any occupation” but slightly more so than “own occupation.”

It is the point at which short-term benefits become long-term benefits that insurance companies will act most aggressively to deny benefits. They may simply suggest that the individual is refusing to make an effort to find work or that they have ignored a doctor’s recommendations for recovery.

The insurer often enlists their own medical experts to conduct an examination, in the hope that the claimant will be cleared to work. Or, through surveillance, they will try to catch the claimant doing something incriminating.

Because of certain limitations on timing, it is important to act quickly once benefits have been denied. You may have a strong legal case that, with the help of a qualified disability lawyer and medical experts, can be ended quickly and favourably.