Think of an “own occ,” or “own occupation” policy as a long term disability insurance policy that insures not you the individual, but your occupation. If you are surgeon, the LTD policy is insuring your ability to perform as a surgeon. Not as an office manager, not as a medical sales person: a surgeon. And if you are a specialist, then your insurance policy is insuring your ability to perform the specific tasks of that practice. An orthopedic surgeon performs tasks that are markedly different than a neurosurgeon or a vascular surgeon.
Let’s get further into the details. If you are an orthopedic surgeon and a large part of your practice involves setting broken arms, rebuilding knees and hips, you have a very physical practice that requires a fair amount of hand, arm, neck and back strength. A neck injury that makes it impossible for you to hold your head up at a particular angle may mean that you can no longer perform surgery as you did before the injury or illness.
If a disability insurance claim is filed for an own occupation policy, the insurance company cannot insist that you can earn an equivalent and suitable income by teaching and selling orthopedic medical equipment. Your insurance policy insured your ability to perform surgery.
If you are an orthopedic surgeon who is a part owner of a busy practice with several partners, associates and staff, the insurance company may attempt to show that your income is not from your own surgical practice, but from your being an owner of a medical office.
This is a typical strategy from long term disability insurance company. We have helped many clients who are confident that their own occupation policy is in place and think that they will not have to worry when it comes time to file a disability policy. They are surprised and dismayed when benefits from what they thought was a better policy are challenged just as aggressively as an “any occ” policy.
One last thing to consider: we have had situations where the insurance company used Occupational Guidelines that were so out of date as to be ridiculous. It’s important to be mindful of the specific tasks associated with your practice – lifting, bending, using large medical devices or small – when the claim forms require job descriptions.
If you have an “own occ” policy and are being asked to describe your job, be careful. This is an area where many claims go from bad to worse. If you have questions, call our office to learn how we can help.