If you have a disability insurance policy, you probably assume that if you’re unable to perform the duties of your job because of your medical condition, you’re entitled to benefits under your policy.
Not so fast! You may be surprised to learn that most disability policies don’t insure you from being unable to perform the duties of your job – instead, they insure you from being unable to perform the duties of your occupation.
What’s the difference? Well, as insurers will tell you, they are concerned about insuring people when they don’t know what those people are doing. There are too many jobs with individual specific duties performed in a variety of idiosyncratic ways for insurers to keep track of. As a result, they only insure the “type” of job you have, i.e., the job as it is typically performed in the national economy.
Thus, if your occupation is working as an office assistant, but part of your job also involves manual labor, the insurer won’t pay you benefits if you can’t do the manual labor part of your job because most office assistants in the national economy don’t perform those duties.
But that’s not all. Most insurance policies only insure you from being unable to do perform the duties of your “own occupation” for a limited time period – usually two years. After two years, the insurer will stop paying benefits unless you can demonstrate that you are unable to perform the duties of “any occupation.” “Any occupation” can be defined in many different ways, but usually insurance policies define it as an occupation that is consistent with your age, education, background, and experience.
As a result, even if you’re unable to work in your old job because of your disability, the insurer can terminate your benefits after two years if there is some occupation you can perform that’s consistent with your background and your limitations.
This is just one example of how insurance policies don’t always say what you think they say. Insurers are constantly carving out exceptions and inserting limitations into their policies to limit their exposure. If you have had your claim denied based on one of these exceptions or limitations, please contact Kantor & Kantor for a free consultation at 800-446-7529 or use our online contact form.