The Difference Between “Any Occupation” and “Own Occupation” in Long-Term Disability Claims in Alberta
When you are working and have disability insurance, insurance companies ensure that you meet your obligations and make your payments. Unfortunately, when the same insurers owe you benefits, they often do not live up to their obligations with the same consistency.
Being unable to work due to physical or psychological limitations is challenging for several reasons. You must:
- cope with your health issues;
- attend medical appointments;
- stress about financial uncertainty;
- apply to disability insurer for benefits; and
- if approved, try to keep your benefits.
Your insurer is obligated to offer you benefits that are consistent with your insurance policy. These documents are complicated, technical, and not easy to understand. Hopefully this article offers some guidance on some key elements of long-term disability (LTD) policies, which typically take effect after other, shorter-term disability benefits have been exhausted.
If you and your doctor agree that you are unable to do any of the essential elements of your work, then your insurer should approve you for wage loss benefits. The wage loss replacement is defined under the insurance police as based on your “own occupation” and is typically 60-70% of your income. These benefits may or may not be taxable. Even when disability insurers approve your benefits at the outset, that is not the end of the story. To maintain your benefits, you must:
- regularly see your health team;
- generally follow their advice for treatment and medication;
- co-operate with your insurer by sharing your records; and
- possibly see a doctor of the insurance company’s choosing.
If you remain off work for 2 years, there is something that you should know: there is a significant change to the disability test at the 2-year mark. After two years, most policies change the definition of what it means to be disabled. To continue to receive benefits after that point, you must meet the test to be disabled from “any occupation”. The distinction between “own occupation” versus “any occupation” isn’t as simple as it sounds.
Contrary to logic, “any occupation” in insurance terms does not literally include any occupation. Typically, “any occupation” is limited to a job with similar pay. To qualify as disabled from any occupation, the position needs to pay a percentage of your prior income. The percentage is typically in the 60-70% range. Therefore, a surgeon who can’t work has very few options that would satisfy the “any occupation” test. However, if you earned a minimum wage salary before your disability, most other positions will meet this threshold. To be clear, not all policies are identical, and it is important to consult a lawyer to review your specific policy and know your rights.
Disability insurers use this change of definition to deny many disabled people their wage replacement benefits. At Preszler Injury Lawyers, we find most of our long-term disability cases stem from a decision to cut off disabled people when insurers switch between one’s “own” and “any” occupation. Often the denial due to the change in definition is not consistent with their policy, however.
Insurance companies are hoping you accept their denial. They will inform you that you are entitled to appeal within their organization. Unsurprisingly, most appeals do not lead to a change in a decision. If your disability insurer denies you benefits during either the own or any occupation period of your policy, please consult a lawyer to find out your rights.
Our Calgary long-term disability lawyers will speak with you during a complimentary free consultation if you need legal help pursuing a long-term disability claim. Call us anytime, toll-free, at 1-888-494-7191 to set up a free initial consultation today.
