What Does Specialty Own Occupation Really Mean?

Transcription

1 What Des Specialty Own Occupatin Really Mean? Plicy definitins are cnfusing, nt nly t cnsumers but als t many f the insurance prfessinals wh sell them. Belw we will try t prvide an understandable explanatin f the different types f ttal disability definitins and hw they wrk. It is critical t understand that it s nt what the MARKETING MATERIAL says that gverns hw yur plicy defines ttal disability. It s what the plicy definitin says. Ttal Disability definitins d three things: Define what yur ccupatin is (this is where the Specialty language cmes int play). Define what criteria yu must meet in rder t be cnsidered ttally disabled frm yur ccupatin. Define what happens if YOU CHOOSE t return t wrk in anther ccupatin. 1) What is the definitin f yur ccupatin? The best plicies define yur ccupatin as yur regular r wn ccupatin t age 65. This means the insurance cmpany cannt require yu t wrk in sme ther ccupatin that they think yu are qualified t wrk in, if yu are ttally disabled frm yur wn ccupatin. Plicies that insure yur ability t wrk in yur wn ccupatin t age 65 are typically referred t as: Regular Occupatin (Reg. Occ) t age 65, Yur Occupatin (Yur Occ) t age 65, r Own Occupatin (Own Occ) t age 65. Yu shuld cnsider these names interchangeable. It s nt the term used that differentiates ne ttal disability definitin frm anther; it s hw the insurance cmpany writes the definitin f ttal disability. S read yur definitin f ttal disability carefully. Dn t assume yu understand what it means just because yur brker says yu have Own Occ t age 65. What is Specialty Own Occ? Specialty Own Occ further defines and narrws what yur ccupatin is. It means that fr purpses f defining what yur ccupatin is, the disability cntract specifically states yur ccupatin is yur legal specialty, assuming yu are practicing full time in a recgnized specialty. If yu are nt practicing in a specialty area f law but have a general practice, then Specialty Own Occ means yur ccupatin is defined as the generalized practice f law, instead f a sub-specialty. Mst insurance plicies d NOT include this specialty language. They make statements similar t the fllwing, yur ccupatin is the ccupatin r ccupatins yu are engaged in at the time f disability. Is there a difference between these definitins? That s the millin-dllar questin and it s a very cmplicated ne. T answer this questin, yu first need t understand what s required t qualify fr ttal disability benefits. 2) What criteria must yu meet t prve yu are ttally disabled frm yur ccupatin? Mst carriers state yu must be unable t perfrm the material duties r the material and substantial duties f yur ccupatin. The insurance cmpany reviews yur jb duties, at the

2 time f claim, and identifies which f thse duties they cnsider material. If yu cannt d any f thse duties, then yu are ttally disabled. If yu can d sme f the duties r all f the duties but fr less than full-time yu are cnsidered partially r residually disabled. With respect t the practice f law, all legal specialties require the attrney t wrk with his/her mind, be able t cmprehend and cmmunicate cmplicated subject matter and deal with stress. Trial attrneys must be able t handle the physical and mental rigrs f ging t curt. Are there ther material duties that an attrney might perfrm? It depends n what yu are ding at the time f claim. Are yu teaching tw days a week r managing the firm? If s, these duties culd be cnsidered material als, even by the cmpanies ffering Specialty Own Occ. Therefre, if yu were ttally disabled frm practicing law but culd still teach tw days a week and/r manage the firm (and had been ding s befre yu were disabled), yu might nt be cnsidered ttally disabled. Belw is an example t further illustrate the prblem(s) f defining ttal disability fr an attrney. Example Yu are a full-time trial attrney Yu are ttally disabled frm ging t curt BUT Yu ARE able t wrk in anther area f law where litigatin is nt necessary and yu chse nt t. In the case f trial attrneys, everyne wants t believe that if they cannt g t curt, the insurance cmpany will cnsider them ttally disabled. Trial attrneys negtiate settlements withut ging t curt. They d research, file mtins, draft dcuments, take depsitins, and meet with clients. All f these duties can be cnsidered a material part f being a trial attrney. S, if yu can still d these things but cannt g t curt, are yu cnsidered ttally disabled r nt? Is it even realistic t think yu culd have a medical cnditin that wuld keep yu ut f a curtrm but allw yu t d all these ther duties? If yu have a letter frm the claims department f the insurance cmpany issuing yur plicy stating, if yu can t g t curt yu will be cnsidered ttally disabled, yu shuld qualify as being ttally disabled under the example abve. Hwever, withut such a letter, yu have n guarantee f hw yur disability will be treated fr the reasns described abve. Let s take ur example a step farther. Yu are unable t g t curt but chse t stay and practice law in a specialty that des nt require yu litigate, say estate and business planning. Yu see clients, advise them n hw t set up wills and trusts t minimize estate taxes, draft these dcuments, incrprate their businesses, write their buy-sell agreements, etc. Hw are yu ging t prve t the insurance cmpany that yu can d these things but cannt d the nn-litigatin parts f a trial attrney s jb and turn the trials ver t ne f yur partners? In bth f these examples, the insurance cmpany is ging t want t pay yu partial/residual disability benefits, rather than ttal disability benefits. Keep in mind, insurance cmpanies aren t in the business f writing ttal disability checks t every attrney that claims he r she can n lnger g t curt. Yu have t PROVE yu are ttally disabled, as defined in the plicy. Finally, insurance cmpanies that d NOT include specialty language in their plicies CAN define yur ccupatin as yur specialty in law. Sme f these carriers claim t d just that.

3 Hwever, unless yu have a letter frm the claims department stating they will cnsider yur inability t g t curt a ttal disability, yu have n guarantee a claim will be paid this way. If yu are nt a full-time litigatr, the Specialty definitin has little, if any, value. Fr example: Hw are yu ging t cnvince an insurance cmpany that yu are unable t practice yur specialty f real-estate law but are able t practice as an estate planning attrney? While each specialty requires different knwledge, they bth require the same skill set. Fr nn-litigatrs and part-time litigatrs the Specialty definitin des nthing t narrw yur ccupatin because the requirements t practice in these areas f law are similar yu have t be able t think, cmprehend and cmmunicate cmplicated subject matter and deal with stress. Therefre, either yu can practice law r yu can t. S, is a plicy with Specialty Own Occ better than a plicy withut Specialty Own Occ? If yu are a full-time trial attrney and that is the ONLY DIFFERENCE in the tw cntracts, yes. It des prvide a mre narrw definitin f what yur ccupatin is, which is gd fr yu. Hwever, yu need t make sure there aren t any ther differences in the cntracts and determine if the extra premium is wrth the perceived benefits f Specialty Own Occ. Regardless f whether r nt the plicy has the Specialty Definitin, ne f the mst imprtant parts f the definitin f ttal disability is hw lng the plicy will pay if yu are ttally disabled frm yur wn ccupatin. The best plicies will pay t age 65. This is where the term Own Occ t 65 came frm. Sme plicies nly insure yu in yur wn ccupatin fr 24 r 60 mnths. Thereafter, in rder t be cnsidered ttally disabled, yu must prve t the insurance cmpany yu cannt wrk in any ccupatin which yu are suited fr based n educatin, training, r experience. This allws the insurance cmpany t reduce r stp yur benefit payments if they have a medical pinin saying yu can wrk in anther ccupatin, even if yu refuse t d s. This restrictin is fund mst frequently in Grup LTD (which insures everyne in the firm) r in assciatin grup plicies. 3) What happens if YOU CHOOSE t g back t wrk? There are three types f Own Occupatin t age 65 definitins. All three differ in hw they pay claims if YOU CHOOSE t return t wrk in anther ccupatin while yu are ttally disabled frm yur wn ccupatin. The Specialty definitin can be attached t any f these three definitins. True Own Occupatin t age 65 (True Own Occ) : This definitin f ttal disability says if yu are ttally disabled frm yur wn ccupatin and yu chse t wrk in anther ccupatin, 100% f the benefit is payable fr the entire benefit perid. Benefits are NOT reduced by incme earned in anther ccupatin. This is the definitin that insurance agents will tell yu is the best definitin f ttal disability. Why, because if yu are ttally disabled frm practicing law yu cllect full benefits, regardless f what yu d r hw much mney yu make. S, the true value f this definitin is it allws yu t make mre mney ttally disabled than wrking full-time as an attrney. This definitin is NOT available thrugh any Grup LTD r assciatin grup disability prduct we are aware f, even if their marketing material seems t say it is. Is there a dwnside t True Own Occ? Sme cmpanies ffering True Own Occ limit benefits fr mental and nervus disrders (which include stress r stress related cnditins and typically substance abuse) t 24 mnths. Since stress related illnesses are ne f the leading causes f disability this is NOT a prvisin yu want t have in yur plicy. In additin,

4 plicies with True Own Occ definitin are mre expensive than plicies with the ther types f Own Occ t age 65 definitins. Mst Individual prducts available tday ffer Own Occupatin and nt wrking t age 65, assuming yu have an age 65 benefit perid. This is the best definitin we have seen in a Grup LTD r an assciatin grup plicy. This means if yu are ttally disabled frm yur ccupatin and YOU chse nt t wrk in anther ccupatin (the insurance cmpany cannt frce yu back t wrk in a new ccupatin), 100% f the benefit is payable t age 65. With mst f the Individual Disability Incme prducts, if YOU chse t wrk in anther ccupatin and earn less than 25% f what yu did as an attrney, 100% f the benefit is still payable. With mst f the Individual Disability Incme prducts, if YOU chse t wrk in anther ccupatin and earn mre than 25% f what yu did as an attrney, yur incme lss is calculated and that same percentage f yur ttal disability benefit is paid t yu. Example: If yu were ttally disabled frm practicing law, wrked in anther ccupatin and had a 60% incme lss, then 60% f the benefit fr ttal disability wuld be payable. Yu must have at least a 20% incme lss t qualify fr this benefit. Transitinal Own Occupatin, t age 65 is a relatively new definitin. The difference between this definitin and Own Occupatin and nt wrking is, if YOU chse t wrk in anther ccupatin the disability benefit is NOT reduced unless yur benefits fr ttal disability plus the incme frm yur new ccupatin are MORE than 100% f yur incme befre disability. Example: If yur incme prir t disability was $20,000 per mnth, yur Disability Incme benefit was $10,000 per mnth, and yu were ttally disabled frm practicing law but yu chse t wrk in anther ccupatin, yu culd earn up t $10,000 per mnth in the new ccupatin withut the Disability Incme benefit being reduced. Cnclusin Tday, plicies ffering attrneys True Own Occ t age 65 may limit benefits fr mental and nervus disrders (which include stress r stress related cnditins and typically substance abuse) t 24 mnths and/r have higher premiums than plicies with Transitinal Own Occ r Own Occ and nt wrking. The nly advantage f True Own Occ is it desn t reduce yur ttal disability benefit based n hw much yu earn in anther ccupatin. S, yu need t decide if the ability t earn mre disabled than wrking full-time as an attrney is: 1. realistic Where d yu find a jb that generates enugh incme that when cmbined with yur benefit fr ttal disability exceeds 100% f what yu made as a full-time practicing attrney, keeping in mind that yu have a serius medical prblem that has caused yu t NOT be able t think, cmprehend and cmmunicate cmplicated subject matter and/r deal with stress? 2. If it is realistic, is it wrth the extra premium fr the True Own Occ definitin and having the 24 mnth limitatin fr mental and nervus disrders, if this restrictin is included in yur plicy?

5 What is f critical imprtance is having Own Occ t age 65 s that the insurance cmpany cannt frce yu back t wrk in any ccupatin after a specific perid f time (typically 24 r 60 mnths f ttal disability) and benefits that pay t age 65 fr mental and nervus disrders. If yu want t pay the extra premium fr Transitinal Own Occ r True Own Occ d it. Hwever, NOT DOING IT des NOT mean yu have made a huge mistake r that yur cverage is inadequate. T make matters even mre cnfusing, the specialty definitin can be included in any f the three types f Own Occupatin definitins (True Own Occ, Transitinal Own Occ, r Own Occ and nt wrking). Example: Yu can have a plicy that has True Own Occ r True Specialty Own Occ r Own Occ and nt wrking r Specialty Own Occ and nt wrking, etc. Specialty Own Occ is anther ne f thse plicy prvisins that sunds sexy but, in the real wrld f law, may nt be any different than Own Occ t age 65, fr any specialty ther than full-time trial law. Even if yu are a trial attrney, unless yu have a letter frm the claims department f the insurance cmpany stating yu ll be cnsidered ttally disabled if yu can t g t curt, yu have n guarantee yur plicy will pay that way. If yu ve stuck with us this lng, hang in there fr a few mre paragraphs. A few ther majr prduct differences The Catastrphic Disability Benefit (CDB), ffered by sme Individual Disability Carriers, allws yu t insure up t 100% f earnings, in the event yu are disabled by a catastrphic disability. Catastrphic disabilities are typically defined as disabilities that result in the inability t perfrm tw r mre activities f daily living, r the permanent lss f use f tw limbs, r speech, r hearing in bth ears r sight in bth eyes, r the disability is caused by a cgnitive impairment (e.g., Alzheimer s). Many plicies that were issued prir t 2006 d NOT cntain this rider. It s very inexpensive and shuld be included as part f yur cverage. Benefit Update (BUR)/Future Increase Optin (FIO) riders are ffered by mst Individual Carriers. They guarantee that every 1, 2, r 3 years yu have the ptin f increasing yur benefit, regardless f yur health, if yu qualify financially. This prvisin is very imprtant fr attrneys wh expect their incmes t increase significantly in the future. Mst cmpanies charge an extra premium fr these riders. Autmatic Increase Optin (AIO)/Future Benefit Increase (FBI) riders are ffered by sme Individual Carriers. They autmatically (n medical r financial underwriting) increase yur benefit by a stated amunt (typically 4% r 5%) r by the change in the CPI, fr 5 years. After 5 years, yu can renew the rider if yur current cverage des nt exceed what yu qualify fr based n yur incme. Mst carriers ffering this benefit charge an extra premium fr it. Yu can request a persnalized premium qute and receive the actual plicy definitins by returning t the Hme Page and clicking the Request a Qute buttn. If yu wuld prefer t speak with a Disability Specialists Advisr, call (888) (7:00 am t 4:00 pm Muntain Time). Just identify yurself as an assciatin member when yu call and yu will be given infrmatin n the prgrams in which yu are interested.

6 Take the time t talk t a Disability Specialists Advisr and review yur current cverage. It culd save yu premium dllars and/r dramatically increase the amunt f benefit yu cllect if catastrphically disabled. This article is nt intended t be legal advice r a cmplete cmparisn f the prducts ffered thrugh the different carriers. Our intent was t pint ut the differences in sme f the mre imprtant definitins f disability. Our representatins are based n the plicy infrmatin we reviewed frm a variety f Individual and Assciatin Grup prducts. These representatins are nt binding t the insurance cmpany underwriting the prducts. The actual plicy prvisins will determine hw claims are paid.