Personal Injury Cases: Moving on to Better Things

The "Own Occupation" Clause And Your Long-Term Disability Claim

When you've suffered any kind of illness or injury that has left you unable to work, you may find yourself needing your employer-offered long-term disability insurance. Unfortunately, receiving long-term disability isn't as simple as just filing a claim. In fact, many claims are denied. One of the most common reasons for long-term disability claims to be denied is because of the "own occupation" clause. Here's what you need to know about this clause and your claim.

It Seems Simple

At first glance, the "own occupation" clause seems pretty simple and straightforward. From a plaintiff's perspective, it should be. After all, this clause states that if the insured is no longer able to work in their own occupation, doing the job duties demanded of them at their job, they may qualify for long-term disability.

The Interpretations Vary

Unfortunately, this seemingly clear qualifier can actually be quite confusing. When it comes to the actual application of that clause, the interpretations of it can vary. Remember that most insurance companies are looking to save money, so any time they can deny a claim, they will.

The law allows for defendants in a long-term disability case to take a looser interpretation of the "own occupation" clause. Instead of having to consider the actual job duties of the individual filing the claim, they are allowed to assess the job duties based on the national average job responsibilities for their industry and type of position.

The Benefit Of An Attorney

If you will be filing a long-term disability claim, the first thing you should do is retain an attorney. He or she can advise you throughout the entire process and will be an invaluable resource in the event that the insurance company tries to contest the "own occupation" definitions. 

Since the national average job expectations can vary widely from one field to another, it's helpful to have an attorney on your side who can do the research and be prepared for whatever argument the insurance company might make.

It is important to have that legal support because your specific job may include physically demanding job duties that aren't defined as expectations throughout the industry but are unspoken requirements. Your attorney can help to argue this in court on your behalf.

The more you understand about the "own occupation" clause and your long-term disability claim, the easier it is to see the importance of having legal support. Reach out to an attorney near you today for more information.