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The misleading nature of "Own Occupation"

I was recently asked to review a claim denial by a well know disability insurer for a nice lady who suffered a terrible crush injury to her foot. She had worked at a production facility where her job duties required her to be on her feet for extended parts of the work day. Her employer was not able to accommodate her standing restrictions so she filed a claim for LTD benefits with Lincoln Financial. The Lincoln policy defined her "Own Occupation" as a collective description of related jobs, as defined by the US Department of Labor Dictionary of Occupational Titles. It includes any work done for pay or profit, regardless of: 1. whether such work is with the employer, or some other firm...; or 2. whether a suitable opening is currently available with the Employer or in the local labor market."

Despite the fact that her employer would not allow her to return to work if she was unable to stand for extended periods of time, Lincoln's in-house vocational consultant determined that her Occupation was best defined as a Project Planner. Lincoln then denied her claim for benefits finding that her "Own Occupation" could be performed sitting most of the time at some other employer. Since she had already exhausted her administrative remedies we were unable to offer any evidence to supplement the record.

This is a classic example of the difficulty with LTD claims. The insurers policy language allows them to disregard the actual duties of a claimant's own job in favor of some imaginary "collective description of related jobs" which, in effect, turns logic on its head. Even though your own employer specifically says you must be able to stand for 80% of the day, Lincoln says "your occupation" can be performed sitting most of the time.

When this Alice in Wonderland view is coupled with the discretionary review incorporated in most policies it is no surprise that disability insurers post exorbitant profits.

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