Own OCC disability claims
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UPDATED: Aug 13, 2020
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Purchasing an own occupation disability income insurance policy will ensure that if you are unable to perform your current occupation, your disability benefit payments will start, providing you with substitute income. Own occupation disability insurance gives professionals a plan that provides coverage when they are no longer able to perform the job they were educated and trained for due to a disability.
What is Own Occupation Disability Insurance
An own occupation disability insurance plan provides coverage if you are unable to perform your current occupation, even if you can take on other work. The following disability benefits are commonly offered with an own occupation insurance policy:
- Recovery Benefits– Recovery benefits are for individuals who can work full time at the same profession after their disability, but still face a loss of income because of the effect of their injury. An example would be a mechanic that on average worked on 4 cars in a day, however, after a stroke can only work on one car, while spending the rest of the full time hours working on other thingsÃ¢â‚¬”books for his business, ordering parts, etc. Recovery benefits can pay him the difference in income level that he loses by repairing fewer cars.
- Total Disability Benefits–Total disability benefits are available to a person whose injury prevents them from engaging in their prior occupation, but who can still work in a different, related capacity. An example is a practicing surgeon who develops a hand tremor and cannot perform surgeries anymore. However, the surgeon is able to work as a hospital administrator or chief of medicine. Although still working full time, the surgeon would be eligible for total disability benefits because he cannot perform the skilled job for which he was insured under his own occupation insurance policy.
- Residual Benefits–Residual benefits are available to policy holders who can return to work, however, cannot work full time. The benefits are designed to make up the difference between full time and part time salary.
When you purchase own occupation disability insurance, make sure you understand what benefits are included in the policy and add any additional coverage that you need. If you would like to get a free quote on an own occupation disability insurance policy, click here to visit the Free Advice quote center today.
How Insurance Companies Manage Own Occupation Disability Insurance Claims
When own occupation disability insurance rose in popularity, many insurance companies provided generous benefits. However, when the time came to pay out the benefits, the companies realized their plans were not profitable and made strong efforts to prevent paying claims in full. This mindset can make it difficult to file a disability claim under your own occupation policy.
One way an insurance company can prevent you from collecting own occupation insurance benefits is to simply deny the disability claim. An insurance company can challenge your allegation that a disability exists which prevents you from doing the functions of your job, and can refuse to pay the claim if it determines that you do not qualify for benefits under the policy. The claims process for own occupation disability insurance can be long and confusing, which provides ample opportunity for the company to find a problem with your claim that justifies denying it.
Denying claims can be messy and insurance companies may take a seemingly friendly approach to short paying an own occupation disability policy. After you file an own occupation disability insurance claim, your insurance company may offer you an Advanced Pay and Close (APC) settlement that provides you with a lump sum payment without requiring you to go through the claims process. The APC check is an amount of money based on an estimate of how much time you will be out of work generated by the insurance company’s in-house physicians. The terms of the APC are generally as follows:
- The check covers the amount of time you will miss work due to your disability
- You will not have to fill out any additional claims paperwork
- The check is an extra contractual agreement and does not change the terms of the existing policy
- Accepting the APC closes the current claim. Should you elect to reopen your claim in the future, the insurance company will require you to start the claims process all over again and will recover all of the money should it find any evidence of fraud or misrepresentation in any part of your claim paperwork.
TIP: You do not have to sign anything to agree to an APC. All you have to do is deposit the check and you have agreed to the terms outlined in the insurance company’s letter. Do NOT deposit the check unless you are confident with the deal.
How to Get the Own Occupation Disability Insurance Benefits You Deserve
The best way to get the benefits you deserve under your own occupation disability insurance policy is to be patient, persistent, and prepared.Make sure you have well documented doctors’ visits, keep up with any claim deadlines that you have to meet, work closely with the insurance company to ensure every piece of information they need is available to them, and do not be intimidated when you work through a claim. It is also critical that you know the benefits you are entitled to under the policy. Do not let the insurance company deny benefits or buy you out by offering less than what you are owed.
If you receive an APC settlement offer, keep in mind that when the insurance company makes an offer it is usually to its benefit and not yours. Consider the following points:
- The APC settlement is based on the insurance company’s estimate of the impact of the disability. Be aware that the company may not have thoroughly reviewed your injury
- The settlement amount seems nice up front, but it will likely not match the amount of the benefits you are owed under the policy.
- Accepting the APC settlement closes your own occupation disability insurance claim for that particular injury unless you return the large payment.
- You do not have to accept the APC! The only real advantage to an APC is avoiding the claims process, but if you are truly disabled then the headache of filing an own occupation disability claim is worth the undertaking.
If your own occupation disability claim has been denied, then you need to review the reason for the denial and prepare to challenge it. Document and keep all records of any interactions you had with doctors, the insurance company, and any other experts or witnesses that you used throughout the claim. Bring everything to an experienced disability insurance attorney for a consultation.
A disability insurance attorney can be a valuable asset whether you have received an APC settlement offer or have had your claim denied. Own occupation disability insurance claims can be very valuable, so make sure you are getting the benefits you deserve. For a free case evaluation, click here to contact a local attorney.