Are you curious about how your job and education impact long-term disability (LTD) claims? The type of work you do and your level of education can significantly influence the outcome of your claim. Understanding how these factors come into play can help you better navigate the claims process and protect your benefits.
Own Occupation vs. Any Occupation
Most LTD policies distinguish between two key definitions of disability:
- Own Occupation: You are disabled if you can’t perform the substantial duties of your specific job.
- Any Occupation: You are disabled only if you can’t perform any job for which you’re reasonably suited based on your experience, training, education, and age.
Most policies apply the “own occupation” standard for the first 24 months of benefits, then switch to the more stringent “any occupation” standard.
What Is “Own Occupation”?
“Own occupation” focuses on whether you can perform the core tasks of your actual job. For example, a cardiovascular surgeon who develops a hand tremor may no longer be able to operate, even if they can still conduct patient consultations. If their policy defines disability based on their specific surgical role, they may qualify for benefits.
However, if the policy defines their occupation more broadly (e.g., “physician” or “cardiologist“), it may be harder to prove total disability, even if they can’t return to their exact job duties.
What Is “Any Occupation”?
After 24 months, most group LTD policies change to an “any occupation” definition. This means the insurance company will evaluate whether you can perform any job that:
- Matches your education and experience
- Is suited to your physical and mental abilities
- Provides income equal to at least 60% of your pre-disability earnings (in most cases)
Under this standard, even if you can’t return to your former job, the insurer may claim you’re able to work in a different role—such as an administrative position or customer service job—and deny further benefits.
The Role of Vocational Experts
Insurance companies often rely on vocational experts to evaluate whether you can work in “any occupation.” These experts use labor market data, transferable skills assessments, and sometimes generic job descriptions to justify their conclusions.
Claimants can also work with their own vocational experts to counter the insurer’s opinions. These professionals can provide more personalized, realistic assessments of employability.
How Education Influences LTD Claims
Your education level becomes especially important when the policy shifts to the “any occupation” or “reasonable occupation” standard. If you have a college degree or specialized training, the insurer may argue you are suited for a wider range of jobs.
However, if you have a limited education or work history in a very specialized field, it may strengthen your argument that you’re not reasonably suited for alternate work.
Some policies define “reasonable occupation” as:
“Any gainful activity for which you are, or may reasonably become, fitted by education, training, or experience and which is expected to result in income of at least 60% of your pre-disability earnings.”
In practice, this means your education doesn’t disqualify you from benefits on its own—but it can affect how the insurer evaluates your ability to do other jobs.
RELATED POST: Is Age A Factor In Long-Term Disability Claims?
What You Can Do to Protect Your Claim
If your claim is denied or you’re concerned about how your education or job background affects your eligibility, it helps to:
- Obtain a detailed job description
- Clarify how your disability prevents you from performing core duties
- Work with your doctor to complete Residual Functional Capacity (RFC) forms
- Consider hiring a vocational expert for an independent evaluation
These steps can strengthen your case and give you a better chance of overturning a denial.
Need Help Appealing a Denied LTD Claim?
The insurance company’s goal is to minimize payouts. At the Ortiz Law Firm, we focus on helping individuals fight back against unfair denials. If your claim was denied due to your education level or the insurer claims you can perform another job, we can help you build a strong appeal. Call (888) 321-8131 or contact us online for a free case evaluation.
