Newfield Law Firm Defends “Occupation-Limited” and “Occupation-Limited” Disability Compensation Claims – Insurance News

Jason Newfield

The Newfield Law Firm, headed by Attorney Jason Newfield in Melville, New York, specializes in “individual” and “all-around” occupational disability claims. Contact us to schedule a free consultation.

One issue Newfield frequently sees involves the definition and claims processing of the policy terms “occupation” and “any occupation.” Occupation can vary by policy, but is typically the occupation in which the claimant is professionally engaged. For example, a surgeon with occupational insurance (usually private disability insurance) is insured in the capacity of a surgeon. Occupation in private insurance is very occupation-specific. In contrast, group LTD (ERISA) insurance may have a more general definition of occupation, generally indicating how the work is typically performed.

Those with “any occupation” disability insurance, or the changed definition of Group LTD (ERISA) insurance, are insured for their ability to work, not for a specific occupation. This is very general and favorable to insurance companies. Therefore, a CPA who is unable to perform the duties required of a CPA may have their disability insurance claim denied because the insurance company may state that the CPA could take another job that is less in demand based on the skills and other experience they have.

Some facts to know:

•Occupational insurance pays benefits only if a person is unable to work in any occupation, taking into account education, training and experience. This is not enough disability coverage for high-income earners, whose income and lifestyle are at risk.

• Some disability policies appear to be occupation-limited but contain provisions that limit the period of occupation-limited coverage to a shorter period, usually 24 or 36 months, when the policy is changed to an occupation. This is more common with ERISA or group LTD policies secured through employment than with individual or personal policies, and is known as a “hybrid” policy.

•Other “own occupation” policies also state that you cannot work in any occupation, severely limiting your ability to work around your disability.

•Disability lawyer Jason Newfield recommends that anyone considering a disability claim locate their original disability insurance policy and review it carefully, looking for provisions relating to “their” or “any” occupation.

“Most claimants purchase disability insurance without understanding what they are purchasing, and when you purchase disability insurance through your employer, there are some significant limitations on coverage compared to individual disability insurance,” Newfield says. “Professionals who have years of education and specialized training should purchase their own occupational insurance.”

There is language in disability insurance policies that does not require surgeons to be retail store clerks. Even in broad terms, there are considerations that must be made. The term “gainful” refers to occupations that may require minimum wage pay, which is a percentage of pre-disability salary. Newfield explains that each policy is different, so claimants should look at their policy to understand what is included in their disability insurance.