Understanding Your Policy’s Definition of Disability

Many doctors or other medical professionals do not know they have developed a condition that could qualified them as disabled.  Doctors generally do not like to admit when they are suffering from pain or that they are limited in their ability to do their job.  Understandably.  It is a noble, rewarding profession that requires years of hard work to attain.  But if you feel you have developed physical limitations that prevent you from doing your job fully or doing it pain-free, it might be time to think about examining your status to determine whether you might qualify for disability benefits.  So, how do you determine whether the conditions and symptoms you may be struggling with qualify you as disabled?  The answer is in your long-term disability (LTD) policy.  Every policy contains its own unique definition, and it is a vital component of a person's claim.

Your “Own Occupation” Versus “Any Occupation”

long term disability insurance claim

Most LTD policies have two definitions of disability: “Own Occupation” and “Any Occupation.”  Typically, the “own” and “any” occupation designations are set on a timeline.  You will be considered disabled if you are not able to perform your “own occupation” for the first two years (typically, some policies are longer) after filing your claim, but the definition will shift to “any occupation” thereafter.  Meaning, if you are able to perform “any occupation,” as defined by the policy, after the first two years, you will no longer be considered disabled and your benefits will terminate.  You can read more about the difference between “any” and “own” occupation here. 


Your Materials Job Duties

The first step to learning how your policy defines disability will be to obtain a copy of your policy, including the “Summary Plan Description.”  Typically, your policy will define the material duties of someone who has your job.  These are the tasks you have to do on a daily basis.  They are often gathered from the national economy not, specifically, from your employer or work setting.  For example, for Dr. Smith, an orthopedic surgeon, who practices, performs operations, and sees patients at ABC Hospital, Dr. Smith's LTD policy will likely contain the material duties for any orthopedic surgeon practicing anywhere in the U.S. not, specifically, Dr. Smith at ABC Hospital. 

Your Job Description

long term disability insurance claim

You should ask your employer for a copy of your job description.  Before reviewing it, take a moment to sit down and write your own version of your job description, setting out all of the physical, mental, and travel requirements that your job requires.  Then compare your version to your employer's version to see if they match.  This is important because you will want to focus your efforts on ensuring your medical records show what symptoms and limitations you have and HOW those symptoms and limitations prevent you from performing the material duties of your job, accurately defined.  Things to consider:

  • Physical requirements: The physical movements you have to undertake. For example: walking, squatting, lifting, pulling, crouching, stooping, carrying, etc.  Also include any fine motor skill requirements of your job, e., inserting tubes, performing injections, surgery, sutures, setting bones,  dental procedures, etc. 
  • Mental requirements: What level of concentration is required, how efficient do you have to be at performing mental tasks (such as math, diagnosis, processing consequences, etc.), and how much information do you have to be able to recall on a daily basis (allergies, medication interactions, informed consent, advice).

Understanding your policy's definition of disability is the first place to start before filing a claim for disability.  It is important to know how your policy defines your occupation and what material duties that entails.  It is also imperative to know what conditions your policy may exclude.  Learn more about typical LTD policy exclusions here. 

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