The majority of group long-term disability insurance plans define disability in two different ways for the purposes of benefits qualification. These two definitions are frequently known as “own occupation” and “any occupation.”
Disability is normally defined as an incapability of performing the essential and fundamental duties of an individual’s “own occupation”. This means a person is required to be disabled from his or her own job or regular occupation for a set length of time in order to begin receiving long-term disability benefits.
If approved for long-term disability under “own occupation” benefits, an adaptation to the definition of disability will occur at a specific time in the future, generally around 24 months after the “own occupation” benefit period began. After the change in the definition of disability, the participant’s qualification is dependent upon his or her ability to perform “any occupation.” The new definition mandates that the individual provide evidence demonstrating both an incapacity to do his or her former job as well as an inability to function in any job for which he or she is qualified, based on education, past work experience, and ability to retrain. If the individual is found to be disabled under the “any occupation” definition, the individual may be entitled to benefits for three years, or more commonly, until a person becomes eligible for Social Security retirement benefits, at age 65.
To ascertain if a plan participant is eligible for benefits, the claimant and his or her lawyer need to thoroughly read all of the documentation of the long-term disability plan, as well as the insurance policy. These documents will provide information relating to the disability definition being used in that specific LTD insurance policy, the available LTD insurance benefits, and the length of the benefits. In every policy, insurance companies use different language, and even the same insurance company may use different language between different group policies. The claimant and his or her lawyer should also compare the language used in the group policy with that contained in the plan documentation, because it is not uncommon for the language to differ.