The Definitions of Disability Claim Policies

There are many different definitions of total disability, all of which depend on the language in your disability insurance policy.  For a disability claim to be paid, your disability must meet the exact definition in your insurance policy.  Different policies can have different terms, so you can conceivably be totally disabled under one policy but not the other.   And public disability insurance – Social Security, state, and/or the VA – have completely different definitions and criteria.

In this post, I am going to give you some commonly used terms and what they mean for your claim.  Your specific disability insurance policy may offer variations of these definitions.

Own-Occupation Disability Insurance

Called Own-Occ, this is the most comprehensive definition of total disability:  the inability to perform the material and substantial duties of your occupation.  Your occupation is separately defined, usually as the duties you were performing at the time of disability.  There is usually a requirement to be receiving appropriate medical care and treatment as well.  Own-Occ allows you to continue or resume working in a different occupation and still be paid disability benefits.

Income Replacement Disability Insurance

Insurance companies that don’t have own-occ plans will often offer income replacement.  While income replacement plans seems similar to own-occ, they have a major difference:  you cannot earn income from any occupation and still receive disability benefits.  Under this type of plan, your disability claim benefit checks will be reduced if you go back to work in any capacity.

Any Occ and Gainfully Employed

These terms are the most common and are often used in group Long Term Disability (LTD) plans.  Any-Occ disability is usually defined as a sickness or injury that prevents the individual from performing any occupation that the insurance company deems the individual is reasonably qualified.  Gainfully employed sets a threshold that you can return to work but can only earn an income much less than your disability benefits.   Filing a disability claim under this type of coverage has many subtle areas where the insurance company can deny your claim.

So…Do not assume anything when it comes to your disability insurance and read your policy carefully, word by word.

No matter what type of coverage you may have, you should always be aware of your exact terms and definitions and how different circumstances may affect your claim.  When filing your disability insurance claim, you want to make sure the insurance company has no reason to question and delay your benefits, as this will lead to a long, arduous process and cause unnecessary stress and worry – when you’re already disabled!  For further information or comments, please feel free to leave a comment on the blog, or visit our website at www.RoyalClaimsAdvocates.com.

Welcome to Our Blog!

Disability Claims Consulting

Hello!

We are Royal Claims Advocates, a disability claims consulting firm dedicated to making sure insurance companies keep their promises and disabled individuals get what they deserve.  With more than 20 years experience working for disability insurance companies, our team has industry-insider knowledge of how claim examiners think, how claims are investigated, and how claims are paid or denied.

While we are not attorneys nor do we practice law or give legal advice, our team of experts understands policy nuances and the significance of certain inquiries that even attorneys and medical professionals don’t realize are critical in obtaining disability benefits.  Sharing the investigative techniques used by insurance companies allow our clients to be prepared.  As professional disability consultants, skilled and experienced members of our team prepare our clients for interviews, independent medical examinations, phone calls, as well as visits by field representatives and vendors.

This purpose of this blog is to share information and explore relevant ideas that make a difference in the disability claim process.  We are always listening for your concerns and questions regarding the complex world of disability insurance.  Please feel free to comment at any time and visit our website at www.RoyalClaimsAdvocates.com for further information.  Be sure to bookmark and visit this blog regularly to continue the dialogue on disability claims!