You may have come across the terms “own occupation” and “any occupation” if you have been considering LTD coverage, or if 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. These policies typically contain various terms, such as waiting periods, maximum benefit amounts, and the length of coverage. Another common term found in LTD policies concerns 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 only that you are unable to work due to a medical condition. This is where the distinction between “own occupation” and “any occupation” becomes important. Most LTD policies provide that you are eligible for benefits for a set period of time, typically two years, if you suffer from a medical condition that prevents you from performing the important duties of your “own occupation.” This means that whatever occupation you are in, firefighter, chef, lawyer, or any other, you will be eligible for benefits for two years, or the specific period set out in your LTD policy, if you are unable to perform the essential duties of the specific job you were working in at the time you became unable to work.
At the two-year mark, or at the end of the period defined in your policy, your insurer will reassess whether you are still eligible for benefits. This reassessment focuses on 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 before suffering from the medical condition that caused you to stop working, when you are reassessed for continued eligibility, your insurer will no longer look at whether you can return to work as a chef. Instead, they will examine whether you can perform the duties of any occupation.
It is important to note that, in this context, “any occupation” does not literally refer to any job whatsoever. Rather, it refers to an occupation for which you are reasonably suited based 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 may argue that the medical condition that prevents you from working at your own job does not prevent you from performing another job, or they may claim that you are obligated to accept a job that is not reasonably comparable to your previous one.
It can be difficult to determine your obligations and eligibility for benefits at this critical stage, especially because the language used in LTD policies is interpreted according to its “legal meaning,” rather than its everyday meaning. For this reason, it is important to consult an experienced LTD lawyer if you find yourself in this situation.