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Own Occupation Disability Denial

Helping Physicians With Long-Term Disability Claim Denials

Many occupations can accommodate some sort of permanent injury or disability. In many situations, people are able to adjust to a modified work setting, performing related or lighter duties while still remaining within the same field. For doctors, however, especially surgeons, dentists, and other hands-on medical professionals, even a small injury can spell the end of a career. If all of your education, training, and experience has led to becoming a particular type of physician, and you suffer a debilitating injury or illness, you might simply no longer be able to perform. At that point, long-term disability (LTD) insurance is meant to kick in.

Unfortunately, insurance providers are always on the lookout for any reason to deny coverage, especially when it comes to expensive LTD benefits for well-paid professionals. One of the principal ways in which physicians are denied LTD coverage turns on the definition of “disabled” in the policy language. Disability policies typically define disability as being unable to remain in the covered party’s “own occupation.” Nailing down the definition of “own occupation,” however, carries its own difficulties.

At Gianelli & Morris, we fight to ensure physicians and other professionals are granted the disability benefits they are owed. If your claim for LTD benefits was denied, our insurance law experts will work to ensure you get the full value of your claim sooner rather than later. Learn more about own occupation denial issues below, and call Gianelli & Morris if you’re a California doctor whose LTD claim was turned down.

Own Occupation vs. Own Specialty vs. Any Occupation

MDs, DOs, surgeons, and dentists typically have disability policies relying on some variety of “own occupation” language. Own occupation policies are meant to protect insured parties in the event that they are no longer able to continue in their current career. Physicians should be able to trust that they can obtain disability coverage if they are no longer able to utilize their years of training, education, and experience for the career they have spent their lives pursuing. Whether they can obtain coverage depends on the definition of “own occupation” in the policy.

Ideal policies will clarify that “own occupation” means “own specialty.” Brain surgeons will get benefits if they suffer injury to their hands. Diagnosticians who suffer cognitive limitations will be will have a valid claim. Covered parties will get the benefits they need when they are no longer able to perform the job duties they have spent their life’s work crafting.

Unfortunately, policies often leave “own occupation” either vaguer or broader. Own occupation might mean, according to claims adjusters, that a physician is not “disabled” unless they are unable to perform any job in the medical field. According to that interpretation, covered doctors must suddenly shift careers, obtaining new training and education, regardless of their age or position, and without disability benefits. Of course, in practice, a lifetime ophthalmologist cannot suddenly become an internist when they lose the ability to perform surgery.

The broadest occupational language appears in “any occupation” policies. Doctors tend not to purchase any occupation policies because of the broad, unfavorable language, illustrating the importance of reviewing your policy language before you buy. Any occupation disability policies allow insurers to deny coverage to injured parties who are able to stay in the workforce so long as they can reasonably perform any job, even if outside the medical field. Short of total paralysis, blindness, or other severely disabling injuries, parties with “any occupation” coverage will have a difficult time obtaining LTD benefits.

Just because the insurance company claims that the policy language excludes your disability does not mean that you are not owed coverage. California law requires ambiguous terms to be resolved in favor of the insured. If your policy is unclear on the definition of “own occupation,” you have the right to appeal any denial and possibly obtain the benefits you are owed. A seasoned California disability benefits denial attorney can help.

Let the Legal Experts Help With Your Own Occupation Disability Denial

LTD insurance policies can be lengthy, dense and highly technical. They are written precisely to give insurers leeway to deny otherwise legitimate claims based on their own interpretation of policy language. Just because they choose to read the policy language in a way that protects their bottom line does not mean that you are stuck without disability coverage. You have the right to fight back, and we can help.

At Gianelli & Morris, we live and breathe insurance policies and can interpret your policy and let you know where you stand if your benefits have been denied. Our experienced bad faith insurance lawyers have the experience, resources, and talent to ensure you get the benefits you are owed. Call Gianelli & Morris today for a free consultation at 888-836-7332.

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