Not All Own Occs Are Created Equal

Make sure your clients understand what the policy’s definition of total disability will provide to their employees at claim time. Does the policy provide what the industry typically refers to as Modified Own Occ or True Specialty Own Occ?

The Standard offers both definitions of total disability. This choice of definitions can give you a sales edge when offering The Standard’s Platinum Advantage GSI to your clients.

Regular Occupation (AKA Modified Own Occ)

Under our Regular Occupation definition, total disability means that due to injury or sickness, insured individuals meet three criteria. They must be:

• Unable to perform the substantial and material duties of their regular occupation
• Not engaged in any other job or occupation for wage or profit
• Receiving regular medical care from a physician

This definition offers strong total disability coverage for most occupations.

Own Occupation (AKA True Specialty Own Occ)

Our Own Occupation definition offers what the industry often calls True Specialty Own Occ.

The main difference between Regular Occupation and Own Occupation: the Own Occupation definition removes “Not engaged in any other job or occupation for wage or profit” from the criteria for total disability.

Under the Own Occupation definition, insured individuals can be considered totally disabled while earning money in another occupation. This is true even if they’re earning the same or more income than before the disability. The Own Occupation level of income protection can be particularly important for specialized professionals.

Claim Example

Consider this example* of what may happen at claim time:

Doug is a surgeon with a Platinum Advantage GSI policy that includes the Own Occupation (True Specialty Own Occ) definition. A disability makes him unable to perform surgical duties, the substantial and material duties of his surgeon occupation. Doug accepts a new position that he is able to perform despite his disability — an adjunct professor at a medical school. Because Doug’s policy included the Own Occupation definition, he can receive the full monthly benefit while earning income in his new occupation.

If Doug's policy had included the Regular Occupation (Modified Own Occ) definition, Doug wouldn't have qualified for a total disability benefit while earning income in his new occupation. Because he engaged in another job or occupation for wage or profit, he would have no longer met the criteria for being totally disabled.

* Example based on Platinum Advantage GSI coverage and benefits. This is for illustration purposes only and may not reflect actual claim experiences.

Read the Fine Print

When choosing an Own Occupation definition, choose the best fit for your cases. Consider the occupations of professionals covered and the income protection needs of the client. This will help you determine if Modified Own Occ or True Specialty Own Occ is the most appropriate recommendation.  

When comparing carriers, read the contract language carefully to ensure you’re offering the Own Occ definition your client wants. Some carriers offer own occupation coverage that, on closer look, you’ll see is actually Modified Own Occ.

If you have questions about Own Occupation choices, please contact your GSI sales representative.