Definition of Total Disability at Claim Time: Own Occ vs. Regular Occ
Provide expert advice about how Total Disability changes when a client adds an Own Occupation Rider to a Platinum Advantage policy. This article explains exactly when and why a client might need the Own Occupation Rider.
First, let's look at the base Platinum Advantage policy language:
According to the policy, Total Disability means that due to injury or sickness:
- you are unable to perform the substantial and material duties of your regular occupation; and
- you are not engaged in any other job or occupation for wage or profit; and
- you are under the regular care of a physician appropriate for your injury or sickness.
When a client selects the Own Occupation Rider, the definition of Total Disability changes to remove the second bullet, “You are not engaged in any other job or occupation for wage or profit.” This means we may consider the insured totally disabled when injury or sickness makes them unable to perform the duties of their regular occupation even if they earn money in another occupation.
Both the Regular Occupation definition and the Own Occupation Rider state that physicians or dentists who have limited their practice to a single specialty recognized by the American Board of Medical Specialties, American Osteopathic Association Bureau of Osteopathic Specialists or American Dental Association will be considered totally disabled if they can't perform that specialty. With the Own Occupation Rider, this specialty language extends to trial attorneys as well.
With the Own Occupation Rider, if the insured works in another job — even just a different specialty — he or she could still be considered totally disabled, and may qualify for the full monthly benefit. Without the Own Occupation Rider, these medical or legal professionals may not be found disabled and benefits may not be paid.
A couple of key things to note:
- Regular Occupation is the occupation or occupations in which the insured is regularly engaged at the time disability begins. This is not always the same as the insured’s work at the time of application.
- The claims department may request comprehensive income documentation to understand the insured’s total income. However, only earnings from his or her occupation will apply when we determine the amount of benefits that will be paid.
If you have a question about claims, please send us a message by completing the message form. Be sure to select “Claims Questions” in the topic drop-down menu.
Confidence and Compassion
A Note from Greg Ness, Chairman, President and CEO
At The Standard, we’ve been helping people achieve financial well-being and peace of mind since 1906. As the global health crisis continues to disrupt lives, communities and the economy, I am confident we’ll continue helping people when they need us the most. Our company has been through hard times and market volatility before and we will navigate through this challenge as well. As our customers face tremendous stress and uncertainty, we will continue providing support and stability to those who rely on our products and services.
This pandemic is tough on everyone. Our communities are hurting, our families and friends are distressed and some of our most vulnerable neighbors are at risk.
The crisis and the way we collectively respond to it will define a generation. We are rising to the challenge. I know every single employee at our company — along with staying focused on keeping our business running and serving our customers — is looking for ways to make a difference for those most affected by this pandemic. That’s proving true in businesses and homes across the community, the country and around the world.
Part of the tragedy of this disease is that even as we come together to help those most in need, the unique nature of COVID-19 is forcing us apart. We all understand the importance of —social distancing— to slow the spread, but we should remember that’s just physical distancing. I encourage you to find ways to safely connect with those in your neighborhood who may require extra help and with groups in your community that are making a difference and support them however you can. And now is the perfect time to reach out to friends and others and just check in.
To our health care providers, first responders and everyone selflessly setting aside their own fears and concerns to help others during this time — thank you hardly seems enough. These people are true heroes. This crisis reinforces how reliant we are on the many essential services we too often take for granted. We are grateful to so many for continuing to show up with focus and commitment.
We will get through this, especially if we are sustained by the examples of those who make us the proudest right now — family, friends, neighbors and colleagues working together — rather than allowing our fears to guide us. No matter how unsettled we may feel, remember we are not alone. There are so many people in this world trying their level best to help others. And I am certain we will get through this — together.
In times of crisis, we are defined by how we react. Let’s continue to be defined by compassion.
And to our customers, thank you for putting your trust in The Standard. What we sell is a promise to be there when you need us, and that promise is unwavering.
Be safe and well, and stay connected.
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