If you have an employer-provided disability plan that is subject to the Employee Retirement Income Security Act of 1974 (ERISA), you probably realize that you need to provide proof of your disability in order to access those benefits.
You may not, however, realize how your employer’s plan defines “disability.” Before you file a claim, it helps to know whether you have an “own-occupation” or “any-occupation” policy.
What’s the difference? Here’s what you need to know:
Essentially, the provider will look to see what limitations your disabling condition causes and whether those limitations prevent you from doing the regular, material aspects of your job. Since these policies offer pretty broad coverage and claims are often easier to get approved than those for any-occupation policies, most employees prefer these policies.
Except there might be a catch. Own-occupation policies may seem accommodating, but they often have hidden limits that you aren’t aware are there. For example, there may be time limits on how long you can collect benefits — essentially giving you a transition period in which you are expected to find other work. Some modified own-occupation policies also won’t pay if you take any kind of other work — even if it doesn’t pay nearly what you previously earned.
With this kind of policy, you have to prove that you’re unable to do any kind of work that someone your age with your particular skills or education and your experience could do. It doesn’t matter if you have ever held a particular job or not — nor does it matter if that job pays anywhere close to what you earned before your illness or accident.
Naturally, these are generally harder benefits to access because they are so restrictive.
Your ERISA disability plan may be intentionally hard to understand, with deceptive clauses hidden in complex legal terms. Plus, some policies are hybrids that mix features of any-occupation policies and own-occupation policies in unique and confusing ways. You’re also likely faced with strict filing rules and deadlines. Don’t take a chance on losing the benefits you need. Get an experienced attorney’s take on your policy and situation.