The definition of occupation in your long term disability insurance policy seems like it would be a simple one. But it is not. A recent case out of the New Jersey appellate court closely scrutinized Aetna’s attempt to redefine occupation.
Most disability insurance policies say you have to first be disabled from working in your “own occupation.” From there, many policies require you be disabled from working in “any occupation.” However, the “own occupation” period is important because insurance companies sometime try to generalize your occupation to one found in the national economy.
The New Jersey appellate court ruled against Aetna for doing just that when the policy did not allow for it. The policy at issue did not define own occupation. Thus, the law requires that own occupation be interpreted using the plain language of the plan. In other words, own occupation means just that - the claimant's occupation. Not the occupation as defined in the national economy. This is a really important distinction.
What does Own Occupation Mean?
A claimant's occupation may have different duties within their company than it would when defined generally. For example, as in this case, the claimant’s own occupation may require travel whereas the national economy definition of his occupation did not.
In other cases it may mean the difference between sitting all day or going out on sales calls. It may change the physical demand level of the job, i.e. sedentary vs medium level. Those are big differences that can change the outcome of a claim.
Aetna’s attempt to apply a different definition of own occupation backfired. The court saw through it. It is a simple application of the language of the policy. Here, the policy did not define “own occupation,” so the plain meaning of the term applies. That is, the occupation the person was performing when they became disabled.
If you have a denied or terminated disability claim that involves a discrepancy with the definition of occupation, we can help. The first thing we look at, as did the court, is the policy. It is the governing document. From there, we can determine which definition is appropriate.
Having an Experienced Disability Attorney Matters
Because disability insurance law is complicated, it is important to get legal help from a lawyer who focuses on disability law.
As a law firm built to focus disability insurance, all our disability lawyers spend every day working to get our clients disability benefits from insurance companies.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help.
If your claim for long term disability benefits was denied or being delayed by an insurance company, call us to speak with a disability insurance attorney.
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