Disability insurance provides a number of benefits in many different areas. With the many types of insurance, there exists one specific type of coverage that’s designed specifically for a worker’s unique type of occupation. These policies, known as own occupation disability insurance, offer significant benefits that differ from more traditional policies. Most important, it includes what’s known as an “own occupation” provision which offers compensation in the form of 100 percent reimbursement to a short term or long term disability resulting from an illness and or injury that prevents the policyholder from performing his chosen occupation. This is applicable even if that person goes back to work in a different capacity or makes the decision to accept an offer for employment in another industry.
There also exists a slightly different policy that pays if someone loses his ability to work in a certain occupation. If, in the future, the individual returns to work — regardless of what work he performs — he will see his payments decreased. Clearly, “own occupation” policies offer significant advantages over “any occupation” policies. There are provisions that do offer financial compensation in varying amounts, with the monthly premiums depending upon your professional niche, health and general working conditions.
These policies each have their own subjective language and unfortunately, the insurance industry does not regulate the various terms used in long-term disability policies. One carrier’s definition of an “own occupation” policy is not necessarily the same as that of another carrier. Insurance companies will offer own occupation disability quotes and will sell policies as “own occupation” when they are very much aware that the policies do not measure up to the expectations one has when he purchases own occupation disability. No one tells him it’s the company’s own modified version of the policy.
Not only that, but some consumers may not even be aware that they have an own occupation disability policy and don’t discover it until the insurance company attempts to lower their payments if they go back to work in another role.
The Confusion with Own Occupation Disability Insurance
It comes as little surprise that these types of insurance policies are confusing. Many people start out with a clear understanding of what they’re searching for and then after exploring the many offers, they realize just how unnecessarily confusing insurance companies make it. An experienced Palm Harbor “Own Occupation” disability insurance attorney can eliminate much of that confusion and help propel your case through the proper channels. Our goal is to offer advice and guidance through the process of getting the right insurance plan, ensuring you get the amount of coverage and compensation that you need. Or, if you’re injured and need to collect own occupation disability benefits from your insurance policy, our attorneys will represent you, pursuing litigation if this measure becomes necessary.
Let’s consider two successful surgeons with two very different outcomes due to one single sentence in their policies:
Dr. Smith and Dr. Jones are successful surgeons who have built remarkable careers and reputations. Their skills are the best in the state and not surprisingly, each surgeon is in big demand. They each earn more than $20,000 a month and each has an “own occupation” policy. Dr. Jones, however, purchased his as a “limited own occupation”.
Both surgeons maintain their premiums for their respective $10,000 monthly disability payments.
After several years, each surgeon develops medical tremors that will soon affect their ability to perform surgeries on their patients. Each closes his practice and both begin to receive the $10,000 a month income as part of the disability policies they’ve maintained over the years. Neither will be able to work as a surgeon again, but both are brilliant medical professionals.
Dr. Smith decides to consider a career in a different area of medicine and chooses family medicine. After meeting the requirements, he opens a family practice and enjoys great success in that area of medicine, but his lifetime benefit clause ensures he keeps his $10,000 income from the insurance company. This is income that benefitted him when he needed it, but his payment continues the rest of his life anyway.
Dr. Jones, however, has a slightly different long term outcome. The “limited” part of his policy had one specific term that Dr. Jones was unaware existed. It stated that the insured is disabled if he cannot perform the duties of his occupation for the first 24 months of disability. After that time, he will be deemed totally disabled if he is unable to perform any duties at all for which he is “fitted by education, training or experience”. If Dr. Jones goes into another medical practice, his $10,000 payments stop immediately.
Why am I Being Encouraged to Not Seek Legal Counsel?
Unfortunately, insurance companies encourage their own occupation policyholders to not seek legal guidance. Their goal is to cut a check that’s significantly lower than what a disability lawyer would fight for and win on behalf of his client. Insurance companies will tryto limit their liability and boost profits. Some of their tactics run the gamut from misleading interpretation of the confusing policy language to doing things that equate to outright bad faith and poor ethics. And make no mistake, these unethical actions are not limited to smaller insurers; some big name insurance companies often sink to such levels; in fact, one of the largest disability insurance providers in the world has been condemned by 23 different state attorney generals for bad faith practices. It remains in business and continues to write thousands of policies each year. It shouldn’t be this way and it’s difficult to know what kind of insurance company you’re dealing with until it’s time to file a claim.
At the Jeffrey W. Hensley, P.A., we have extensive experience defending our clients’ rights against insurance companies in cases involving own occupation disability insurance policies and other similar policies. Our unique combination of extensive medical knowledge, successful personal injury cases and Jeff’s thirty-plus years of legal experience makes us the best choice for a disability lawyer in Palm Harbor. We fight insurance companies aggressively, whether we litigate your case in court or we find a solution before it gets that far, we will provide you the best opportunities for winning your case and securing the benefits you’re entitled to, especially considering the expensive premiums that come with these types of insurance policies.
Your initial consultation is free, private and fully confidential. Based in Palm Harbor, FL, our law firm welcomes the opportunity to discuss the specifics associated with your case. You’ll have the knowledge you need to decide whether or not to seek legal avenues in your efforts of securing coverage you’ve already paid for. Give us a call and speak to a Palm Harbor “own occupation” disability insurance attorney today. Call 727-781-3433.
The best!!! The Law Office of Jeffrey Hensley PA stuck by me through this long drawn out case and was always there to answer my questions!! Hopefully I never need this amazing team for anything else but if I do they will be my first call!
I am a Vietnam veteran who was exposed to Agent Orange.
Mr. Hensley helped me with my disability claim with the Veterans Administration.
I had been stonewalled by the system, after trying on my own for almost two years. He helped me through a very difficult time and my case settled within several months once he took over.
My wife and I cannot thank you and your firm enough for all that you did.
If you're looking for a good attorney this is the best place to go! Handled my claim fast. Thank you!! 5 Star's not enough!!