The difference between "own occupation" and "any occupation" disability coverage can mean the difference between receiving benefits or not. Policy language defining disability is the most critical factor in long-term disability claims. Understanding these definitions helps you evaluate your coverage and strengthen your claim.
Own Occupation Coverage
Own occupation (or "own occ") coverage defines disability as the inability to perform the material duties of your specific occupation. If you can't do your own job, you're disabled—even if you could work in a different field.
For example, a surgeon with hand tremors might be disabled from surgery but capable of teaching or consulting. Under own occupation coverage, the surgeon would receive benefits because they can't perform surgery.
Any Occupation Coverage
Any occupation (or "any occ") coverage defines disability as the inability to perform any occupation for which you're reasonably suited by education, training, or experience. If you can do any reasonable job, you're not disabled—even if you can't do your own job.
Using the same example, the surgeon would not receive benefits under any occupation coverage if they could work as a medical consultant or teacher.
The Transition Period
Most employer-provided policies start with own occupation coverage but transition to any occupation after a period—typically 24 months. This transition is when many claims are denied. The insurer may have paid benefits while you couldn't do your specific job but denies continuing benefits claiming you can do some job.
Understanding when your policy transitions helps you prepare. Start building evidence for the any occupation standard before the transition.
"Reasonably Suited" Analysis
Any occupation doesn't mean literally any job. You're not expected to take a minimum wage position if you were a professional earning $200,000. Insurers must consider occupations matching your education, training, and experience. The analysis should identify specific jobs you could realistically perform and obtain.
Challenge overly broad any occupation denials. Insurers sometimes claim you could do sedentary work without identifying actual jobs matching your background.
Residual or Partial Disability
Some policies provide residual or partial disability benefits when you can work but at reduced capacity. If you can do your job part-time or with limitations, you might receive partial benefits. Check whether your policy has residual disability provisions.
Material Duties
Own occupation claims focus on the material duties of your job—the essential functions, not peripheral tasks. Identify what duties are truly material to your occupation. A surgeon's material duties include performing surgery; administrative tasks are incidental.
Job descriptions, vocational experts, and industry resources can establish material duties. If you can't perform even one material duty, you may be disabled from your occupation.
Mental/Nervous Limitations
Many policies limit mental health and substance abuse claims to 24 months total benefits. Check your policy for these limitations. A disabling condition may receive unlimited benefits if primarily physical but limited benefits if primarily mental—even if the conditions are related.
Proving Any Occupation Disability
To prove any occupation disability, you need medical evidence of your functional limitations, vocational evidence that these limitations prevent all suitable work, and analysis of what jobs theoretically match your background and why you can't do them.
Vocational expert reports can be crucial. They analyze your capabilities against labor market realities to show you truly can't work.
Insurer Tactics at Transition
Insurers commonly schedule "independent" medical exams (IMEs) just before the own-to-any occupation transition. These exams often find claimants capable of sedentary work, justifying denial under the any occupation standard.
Prepare for IMEs carefully. Understand what the examiner is looking for. Consider having your own expert evaluate you concurrently.
Policy Language Variations
Read your specific policy carefully. Variations in language can significantly affect your coverage. "True" own occupation pays even if you're working in a different field. "Modified" own occupation may reduce benefits if you have other income. Some policies have earnings-based definitions.
Getting Legal Help
Long-term disability attorneys understand how policy definitions affect claims. They can analyze your specific policy language, develop evidence supporting disability under your policy's standard, and challenge improper denials at the own-to-any occupation transition.