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Understanding own-occupation disability

On Behalf of | Sep 15, 2021 | ERISA

In New Jersey, many disability companies offer policies with the term “own occupation” and many who purchase those policies believe that they are covered should they be unable to perform their job duties after an injury. However, it is important to understand what the term “own-occupation” means to determine what your policy covers and what benefits you can receive should you suffer an injury that keeps you from working.

Employee Retirement Income Security Act

Most disability policies are governed by the Employment Retirement Income Security Act (ERISA), a federal law. The law allows disability insurance companies to define the term narrowly which means even if you are unable to perform your regular duties, you may not be considered truly disabled based on the ERISA disability claims requirement of your insurance company. As a medical provider, you may have purchased a disability policy that would cover your income should you become ill or sustain an injury that keeps you from performing in your practice. In most cases, a disability policy provided to a doctor, dentist or other medical practitioner contains the phrase “own occupation”.

What qualifies as own occupation coverage?

When you purchase an own occupation policy, there are limits on how long you can receive disability payments and the policy will likely prevent you from working in any other occupation. There are caps on the total benefits you can receive over the life of the policy and the policy likely defines your covered occupation in much broader terms than you would. In many cases, your ERISA policy may switch from own occupation to “any occupation” after time. If you can do any type of work after this happens, you may lose your benefits. For example, if your policy switches to any occupation and you can act as a consultant for pay but cannot perform surgery, your benefits may end.