LTD: "Own" and "Any Occupation"
The terminology used by an insurer to define “disability” is the most important part of any long-term disability insurance policy. The definition determines when an insured person isn’t liable for disability benefits, and what criteria they must meet in order to receive compensation. When benefits are denied, it’s our role as lawyers with expertise in disability claims to find out the details of our clients’ insurance policy and take legal action against the disability insurer.
There are many different types of disability definitions, such as “Regular Occupation Definition” and “Reasonable Occupation Definition”, but the two main categories of insurance coverage are “Own Occupation” and “Any Occupation”.
Difference between own and any occupation
The “Own occupation” definition of disability states that if an injury or sickness directly interferes with an insured person’s ability to perform a substantial part of their own occupation, they’re liable to access disability benefits. This definition is known as being the most lenient of insurance policies because the injury or sickness only has to prevent the insured person from working their specific job. Although the “any occupation” definition is more difficult to meet, our experience is that disability insurers tend to terminate unfairly and interpret “any occupation” to narrowly.
For example; the insured is a cab driver who suffers a hand injury that inhibits them from driving safely. Under an “Own occupation” definition they would be liable for disability since they can’t perform the essential parts of their job. However, if they were covered by a “Any occupation” policy, it wouldn’t be as simple.
“Any occupation” will only give benefits when the insured is unable to work in any occupation that they’re reasonably qualified for, based on education or previous experience. Sticking with our taxi cab example, if the driver had 10 years of previous work experience as a fast food manager, his injury would have to be assessed according to the daily activities in that field as well. If his hand injury only prevented him from gripping a steering wheel properly and not from coordinating restaurant workers, he could potentially be refused compensation.
Other important factors in LTD claims
In the “any occupation” definition of disability, there’s a lot of room left for interpretation by the judge as to when coverage should be made payable. Factors such as the renumeration of an alternative occupation, and the availability of work for the client, can be argued for and against an insurance claim. A factor that is key in either an “Any” or “Own” insurance policy is expert medical evidence.
Medical evidence of the injury or sickness establishes whether or not the insured is actually unable to work. Having the right expert witness can make all the difference if the issue goes to court - a regular doctor may not be qualified to accurately diagnose a person with depression, but a psychiatrist is.
If you have questions about your long-term disability coverage, or feel as though you’ve been unfairly denied benefits by your insurance provider, don’t hesitate to contact us here or call 1-888-434-0398. We specialize in long-term disability cases, and can secure you the compensation you rightly deserve.
For more information on long-term disability coverage, consider our links below.
Resources on long-term disability:
Reach Canada - Long Term Disability Participant’s Manual