You may have a sense of relief when you finally get your long-term disability benefits. But now that the initial trial is over, there is still the matter of complying with the policy’s rules. One of those rules may be working to keep your benefits.

Disability insurance is intended to protect you from financial risk if you become disabled or sick to the point where you are unable to work. The policy itself contains the definition of “disability”, and whether you qualify depends on what your policy terms as “disabled.” You will have to be “disabled enough” according to the policy’s definition in order to receive benefits. But everything comes down to the type of LTD policy you have.

Own Occupation Vs. Any Occupation

There are two basic types of LTD policies:

• Own Occupation, in which you receive benefits when you are no longer able to work in your current vocation (more expensive)
• Any Occupation, where you are able to work in a different occupation, but can no longer work in your current vocation (less expensive)

For instance, if you are a firefighter, and are injured on the job, you can no longer work in that occupation. Under an “own occupation” policy, you would receive benefits because you were totally disabled and could no longer perform “material and substantial duties” for that job. It would not matter that you could have a second career that was related to your work as a firefighter.

However, under the “any occupation” policy, the same firefighter who was injured on the job may be able to perform “material and substantial duties” for another occupation, i.e., a “desk job,” and will not be considered “disabled.” Only if the firefighter was unable to work in any occupation would the individual be considered “disabled” enough for the policy. “Any occupation” work may also mean workplace accommodations, which can also be used to deny benefits.

Most courts hold to the standard that if an individual is capable of any kind of work, even part-time, the individual is not truly disabled, and can be gainfully employed in any occupation, not just their own. This means that you would not meet the standard of disability.

Unfortunately, there are no standards for income disparity. This means that if you were working in a profession that paid $100,000 per year before your disability, you might still be able to work at a job that paid $15,000 or less, and therefore not be considered disabled. Under an “any occupation” policy, you would be required to work any job you could get, regardless of the salary.

Many LTD group policies provide benefits under the “own occupation” clause for the first two years of disability. After that, the benefits are under an “any occupation” clause.

Contact Houston’s Premier Disability Law Firm

Not many attorneys understand disability filings and appeals, but we specialize in it. With over 4,000 successful cases, we focus on helping disabled people receive the benefits they need. We’ve handled multiple situations that are similar to yours, and have the experience to help you through the process for a successful outcome.  The Herren Law Firm can help you with your application, appeals and legal action to help you get the disability benefits you need. Contact us today at 713-682-8194 to schedule your free consultation. There’s no obligation and no up-front fees.  We only collect if we win your case.