“Own Occupation” Is Not So Simple In Disability Insurance
“Own occupation” has been discussed so much over the years that lately it has taken on a generic appearance. Sort of “one-size-fits-all”. As experienced and knowledgeable disability insurance attorneys in New Jersey and New York, Uscher, Quiat, Uscher & Russo, P.C., knows that nothing could be further from the truth.
“Own occupation” or “regular occupation” are words of art in disability insurance policies. Yet, many times, the “own occupation” insurance coverage the policyholder actually has is not nearly what he or she thought they had. The insured may believe the insurance policy covers loss of income under certain conditions and for a certain period of time, but the insurance contract may not be written the way it was described by the agent or broker when the policy was sold to the insured. Actual coverage may be quite different from what the policyholder thinks it is.
The words “own occupation” or “regular occupation” in a disability insurance policy are vital to doctors, dentists and other high earners who own such policies. They buy disability income policies to protect these high incomes in the event a disabling illness or injury should strike.
Most people have neither the time nor the desire to read the lengthy and complex language of insurance contracts. This is especially true for those who are busy earning high incomes and have little time for anything else. Such a situation has all of the makings of a financial debacle should a disabling health disaster strike.
Many policyholders feel comfortable when discussing their insurance portfolio because they assert that they have “own occupation” coverage, in the event of disabling illness or injury, and believe they have done their duty to protect themselves and their families.
But, when asked what type of “own occupation” coverage they have, they really don’t know. They seem completely unaware of the variety and limits that ordinarily come with this type of insurance:
- Limits on the length of disability payments
- Precluding the insured from working at any other occupation
- Capping the total amount of benefits over the life of the policy
- Defining the covered occupation to cover a broader spectrum of employment than the insured thinks it does
Some policies have definitions of disability which will change from “own occupation” to “any occupation” at a certain point in time, which can mean that if the insured is able do any type of work, their benefits payments may stop.
If an insured feels comfortable with the disability insurance provisions in his or her policy, that’s fine, so long as the policy has been carefully read and fully understood. If not, it may be a ticking time bomb waiting to go off at the worst possible time, when a disabling illness or injury cuts off income.
So, those who own a disability insurance policy should read it carefully. They should be certain they know what it says. A disability insurance policy is the “Bible” if you can’t work. If you are not sure of whether you actually have the “own occupation” coverage you think you have, now is the time to find out.
FAQs About Long-Term Disability Claim Denials for Medical Professionals
Insurance companies frequently deny claims by arguing that:
- Your medical records don’t prove total disability.
- You could still perform “some other occupation” even if you can’t treat patients.
- Independent medical examiners or surveillance suggest you can still work.
- There were errors or omissions in your paperwork.
Because medical professionals often carry own-occupation policies, insurers sometimes misinterpret or misapply that definition to avoid paying benefits.
An own-occupation policy pays benefits if you are unable to perform the primary duties of your specific profession. For medical professionals, that means if you cannot safely perform hands-on clinical work—even if you could theoretically work in another capacity—you may still qualify as disabled. Insurers often challenge this distinction, making legal representation critical.
- Read the denial letter carefully. It will explain why the insurer rejected your claim.
- Request your claim file. Under ERISA, you have a right to see what evidence the insurer used.
- Gather medical evidence. Ask your providers for detailed notes supporting your disability.
- Contact a disability attorney. Appeals under ERISA must follow strict procedures, and missing steps could permanently harm your case.
Most ERISA-governed LTD policies give you 180 days (about six months) to file an appeal. Missing this deadline usually means losing your right to challenge the denial in court later. Acting quickly is essential.
- Comprehensive medical records and test results.
- Physician statements explaining why you cannot perform your professional duties.
- Vocational expert reports showing the physical and cognitive demands of your specific medical role.
- Documentation of lost income or the impact on your ability to practice.
Yes—if you have an own-occupation policy. For example, a surgeon with hand tremors may be unable to operate but could still teach or consult. Under an own-occupation definition, they may still qualify as disabled. However, under “any occupation” policies, insurers may deny benefits if you can work in any role.
- Ensure all necessary evidence is submitted during the appeal.
- Challenge biased insurance company exams.
- Protect your rights if the case goes to federal court.
If the appeal is denied under ERISA, you may file a lawsuit in federal court. However, courts usually only consider the evidence already in your claim file, which is why it’s crucial to build a strong record during the appeal process.
No. Filing for disability benefits is a contractual right under your policy. Insurers may investigate your claim, but asserting your rights will not jeopardize your license or standing as a medical professional.
Doctors, dentists, and other medical professionals rely on specialized skills that often cannot be substituted. A disability that limits dexterity, vision, or stamina may not affect other jobs but directly prevents safe patient care. Insurers often overlook this distinction—making it essential to have an advocate who understands both the medical and legal aspects of your profession.
More Important Facts:
- Over 60% of long-term disability claims are initially denied by insurers. Many are later overturned on appeal when handled correctly.
- Medical professionals (like dentists, surgeons, and physicians) are 2x more likely to file an LTD claim due to repetitive strain injuries and musculoskeletal disorders.
- Insurers frequently dispute own-occupation policies, arguing that a doctor or dentist could work in an “alternative role,” even when they can no longer treat patients safely.
- Under ERISA, you usually have only 180 days to appeal a denial—miss this deadline, and you may lose your rights permanently.
- Most LTD attorneys, including firms like Uscher, Quiat, Uscher & Russo, P.C., work on a contingency basis—you don’t pay unless they win your case.
Seek Advice From An Experienced New York And New Jersey Disability Insurance Attorney
Give Uscher, Quiat, Uscher & Russo, P.C., a call at 201-342-7100 or email us while you are thinking of it. We have dealt with “own occupation” in battling insurance companies for policyholders for more than three decades. We will be truly happy to talk with you.
Do not wait to understand your coverage until after a disabling illness or injury strikes. If you are not sure what type of coverage you really have, find out now, before you end up having to file a claim.
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