Know-It-All: Own Occ vs. Regular Occ

January 25, 2019
Image of three people and one of them in a wheelchair

Which definition of disability is right for which clients? Regular Occupation or the Own Occupation Rider? That often depends on whether they're in a specialized profession. Platinum Advantage offers the flexibility to tailor protection for each client. Use these tips to offer expert advice that can make a difference at claim time.

Regular Occupation — Focuses on Strong, Built-In Protection

First, let's look at the base Platinum Advantage policy language. Total Disability means that due to injury or sickness, your clients 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
  • Under the regular care of a physician appropriate for their injury or sickness

If your clients become disabled, their current occupation(s) at the time of disability will be considered their Regular Occupation. It's smart to discuss their career plans and anticipate whether they may want Own Occupation protection based on a pending specialty.

Own Occupation Rider — Offers Future Flexibility

Available to occupation classes 3A/3P and higher, this rider changes the policy's definition of Total Disability. It removes the second requirement: “You're not engaged in any other job or occupation for wage or profit.” With the Own Occupation Rider, your clients could work in another job or specialty and still be considered totally disabled — and may qualify for full monthly benefits.

Protection for Specialties — Medical, Dental or Legal

Both the Regular Occupation definition and Own Occupation Rider include specialty language for physicians and dentists. Under the Regular Occupation definition, physicians or dentists will be considered totally disabled if they've limited their practice to a single, recognized specialty and can't perform that specialty.

However, by adding the Own Occupation Rider to a policy, they'll be able to work in another occupation or specialty and still collect benefits. Under Platinum Advantage, the Own Occupation Rider extends specialty language to trial attorneys as well.

Consider these examples* of what may happen at claim time:

 

ClientPolicyAlternate OccBenefits
Client:
Emergency Room Physician
Policy:
Platinum Advantage with Own Occ Rider
Alternate Occ:
Adjunct Professor at Medical School
Benefits:
Continues to receive full monthly total disability benefits while earning income in another occupation
Client:
Realtor
Policy:
Platinum Advantage with Own Occ Rider
Alternate Occ:
Consultant for Property Development
Benefits:
Continues to receive full monthly total disability benefits while earning income in another occupation
Client:
Trial Attorney
Policy:
Platinum Advantage; built-in Regular Occ definition of disability
Alternate Occ:
In-House Counsel
Benefits:
Received benefits under the Regular Occupation definition until he returned to work in another occupation

* Examples are based on Platinum Advantage coverage and benefits. They are for illustration purposes only and may not reflect actual claim experiences.

 

Want to help your clients understand the different definitions of disability? Share our Consumer Brochure.

 

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Product Details / Platinum Advantage