January 16, 2009, Newsletter Issue #43: Understanding Own Occupation Disability Insurance

Tip of the Week

Own occupation disability insurance can be very important to medical and other professionals. Most group disability and government disability coverage has what is often called an “any occupation” definition of disability. This language means that you can collect monthly income up to the time when you are able to perform the duties of any gainful occupation. Once you have the ability to perform any reasonable occupation, your insurer can determine that you are no longer disabled and are now ineligible for benefits.

Own occupation disability insurance coverage stipulates that, once you have been considered disabled per the language of your policy, you would remain eligible for benefits until you can resume the duties of your specific specialty. This different definition of disability can be immensely important to a professional with a rare and high level of expertise.

For example, assume the following conditions: You are an ophthalmologist, whose normal workday includes one or more delicate optical surgeries. You’ve suffered an injury to one or both of your hands. Your insurance carrier has certified you as disabled and eligible for disability income benefits. Five months from your date of disability, you’ve regained the general use of your hand(s) but you’re still unable to perform precise, delicate surgery.

If your disability insurance coverage has an “any occupation” definition of disability, your insurance company may determine that you are able to perform the duties of any gainful occupation, though not your specialty, and declares you are no longer eligible for benefits. As you can see, it would be difficult, if not impossible to replicate your earnings as an ocular surgeon through a lesser occupation. If you have own occupation disability coverage, you would still qualify for monthly income benefits until you can resume the duties of your own specialty.

For this reason, medical and other highly specialized professionals should normally consider having own occupation language in a disability income insurance policy.

The above-listed tip is for informational use only. Refer to your insurance policy contract for specific information regarding your coverage and for actual terms, conditions and exclusions. The above statements are general in nature and may or may not reflect the actual terms of your insurance policy.

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