10 More Legal Mistakes Professionals Make When
Filing a Claim for Disability (Mistake #4)

In an effort to provide professionals with more information about how the disability claims process works and identify some of the most common pitfalls for professionals filing disability claims, attorneys Ed Comitz and Derek Funk have compiled an updated list of the 10 most common mistakes we are seeing physicians, dentists, and other professionals make when they file claims under the new post-2000 generation of disability policies (which are much more complex and stringent than the policies sold to professionals in the 1980s and 1990s).

In this post, we’ll be looking at the common mistake of assuming you have a true “own occupation” policy, when in fact you have one of the new “own occupation” provisions that limit coverage and/or makes it harder for you to collect benefits.

Mistake # 4: Mistakenly Believing that They Have a True “Own Occupation” Policy

Most professionals know that they should purchase an “own occupation” policy that provides benefits if they are no longer able to practice their profession. In the past, these policies all contained virtually the same language, so it was easy for the agent to explain the coverage. What professionals don’t realize is that there are now several iterations of “own occupation” provisions and the differences are difficult to explain. Regardless, insurers market all of these as “own occupation” policies because they know that professionals are just looking for these two magic words. Unfortunately, the new policy variations typically contain additional requirements and limitations that restrict coverage and/or make it much more difficult to collect.

A true “own occupation” policy pays benefits if you cannot perform at least one of the material and substantial duties of your occupation and allows you to work in another occupation (that does not have any overlapping duties with your previous occupation). Under these policies, the insured is essentially allowed to “double-dip”—collect benefits under their policy and collect earnings from another occupation. These provisions used to be commonplace in the industry, but now you will likely need to specifically ask your agent for this type of coverage, and you may need to look into policies offered by multiple insurance companies before you find a true own occupation provision.

Some of the more common limitations and restrictions that are included in the new “own occupation” policies include: (1) “no work” provisions that only allow a claimant to collect benefits if he or she is not working in any capacity; (2) “work” provisions that require a claimant to be working in a new occupation before he or she can collect benefits; (3) provisions that offset the monthly benefit based upon the amount of income a claimant earns working in a new occupation; (4) provisions that require a claimant to prove that he or she is unable to perform all of the duties of his or her occupation; (5) provisions that require a claimant to prove that there are no workplace modifications that exist that would allow him or her to perform his or her prior occupation; and (6) provisions that initially provide “own occupation” coverage, but after a certain time frame (usually somewhere between 2 to 5 years) shift to an “any occupation” provision that only pays benefits if the claimant can demonstrate that he or she is unable to work at all, in any capacity, and allows the company to terminate benefits if they think the claimant could be working (even if the claimant is not actually working at the time).

Many of the professionals we consult with checked “own occupation” on their policy application but didn’t bother to read their full policy when it arrived, assuming that it contained true own occupation language. They are then surprised to learn that, upon closer inspection, although their policy contains the phrase “own occupation,” the policy that they have been paying premiums on for years does not actually provide true own occupation coverage.

Action Step:  Read your policy carefully and fully understand the definition of total disability before filing a claim.

To read the rest of the 10 most common mistakes, click here.

To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.

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