What Does Disability Mean In A Long-Term Disability Claim?

When people think of disability, they often picture someone who can’t work at all. But when it comes to long-term disability insurance, the word “disability” can mean very different things—depending entirely on how it’s defined in your policy.

Understanding the exact definition of “disability” in your plan is critical. It’s the basis for whether you qualify for benefits, how long you can receive them, and what kind of evidence you need to provide to prove your case.

Why Definitions Matter

In long-term disability insurance, “disability,” “total disability,” or “totally disabled” aren’t just medical terms—they’re legal terms defined by your insurance company. This definition determines whether your illness or injury meets the standard required for benefits.

These definitions can vary widely from policy to policy. That’s why it’s important to read your Summary Plan Description (SPD) or the full policy language carefully—or have an experienced attorney review it with you.

Common Types of Disability Definitions in LTD Policies

Here are the most common ways “disability” is defined in LTD insurance policies:

1. “Own Occupation” Disability

This definition is the most favorable to claimants. Under an “own occupation” standard, you’re considered disabled if you can’t perform the substantial and material duties of your occupation—even if you could do another job.

This definition is especially important for people in highly specialized occupations, such as surgeons, pilots, or lawyers. If they can’t do their job, they’re considered disabled—even if they could do something less demanding.

However, please note that there is also a difference between a true “own occupation” definition of disability in an insurance policy an “own occupation” definition that considers how the job is typically performed in the national economy. The distinction between these two definitions can make a huge difference in whether a disability insurance claim is approved or denied.

True “Own Occupation” Definition

Under a true own occupation disability policy, you’re considered disabled if you cannot perform the material and substantial duties of your specific occupation, even if you’re capable of working in another job.

Example:

Let’s say you’re a surgeon, and you develop a tremor in your hands. You can no longer perform surgery, but you could still teach medicine or work as a consultant.

• Under a true own occupation policy, you would still receive disability benefits, even if you choose to work in another field, as long as you can’t perform your specific role as a surgeon.

This is the most liberal and comprehensive definition and is preferred by professionals in specialized roles (doctors, lawyers, etc.).

“Own Occupation” as Typically Performed in the National Economy

This is a more restrictive version. It defines your occupation based on how it is generally performed across the country, not the unique way you perform it for your specific employer.

Example:

You’re a trial lawyer who spends most of your time in court. Due to a disability, you can no longer handle courtroom appearances, but you can still do legal research and write briefs.

• If the occupation of a lawyer typically includes a range of activities (not just litigation), and you can still do some of those duties, you may not be considered disabled under this definition.

This version allows insurers to deny claims if any of the general duties of your broader occupational category can still be performed, even if your specific job tasks are impossible.

RELATED POST: Doe v. Prudential – Insurer’s Decision Was Based On The Wrong Occupation

2. “Any Occupation” Disability

This is a stricter standard. Under an “any occupation” definition, you’re considered disabled only if you can’t perform the duties of any occupation for which you’re reasonably suited based on your education, training, and experience.

This makes it more difficult to qualify for benefits—especially if the insurer believes you can perform a sedentary desk job or other role, even if it’s far below your previous income or skill level.

3. Transitional Definitions

Most policies don’t use a single standard throughout the application process. Instead, many start with an “own occupation” definition for the first 24 months of benefits, then switch to an “any occupation” standard after that.

This transition point is a common time for insurers to reevaluate and terminate benefits—claiming you no longer meet the stricter standard. As you approach the 2-year mark, it’s a good time to review your file and make sure your evidence supports the continuing definition.

RELATED POST: Own Occupation vs. Any Occupation in Disability Insurance Claims

4. Other Definitions You May See

Some policies use other variations, such as:

• “Regular Occupation” – Similar to “own occupation” but sometimes defined more broadly
• “Gainful Occupation” – Often tied to your pre-disability income (e.g., can you work in a job that pays at least 60% of what you earned before?)
• “Split Definition” – Policies that combine own/any definitions in a custom way
• “Residual” or “Partial” Disability – For people who can still work part-time or with restrictions, but with reduced capacity or pay
• “Catastrophic Disability” – Sometimes used in individual policies to refer to severe impairments that require assistance with daily living

One Word Can Change Everything: “All” vs. “Some”

Here’s a real-world example of how small differences in policy wording can have a big impact:

• One policy might define disability as the inability to perform “all material duties” of your occupation.
• Another might say “some material duties.”

That one-word difference can mean the difference between your claim being approved or denied!

If the policy says you must be unable to perform all material duties, then you must be completely unable to do any of the core tasks of your job. But if it says some, then even if you can still do some things—but not the core aspects of your job—you may still qualify.

I often joke that this is exactly why we need lawyers: because one word in your policy can make or break your case.

Why This Matters to You

Insurance companies often use these fine print definitions when reviewing or denying claims. They may say:

• “You can still sit at a desk, so you’re not disabled.”
• “You can do a job, even if it’s not your usual job.”
• “You can work part-time, so you don’t qualify.”

But these conclusions often ignore how your condition affects your specific occupation or misinterprets your policy’s definition altogether.

What You Can Do

• Get a Copy of Your Full Policy: Don’t rely on summaries—get the actual language.
• Highlight the Definition of Disability: Determine whether it’s “own,” “any,” or a transitional policy.
• Know the Timeline: When is the definition changing? Are you approaching the two-year mark?
• Match Your Medical Evidence to the Definition: If your policy requires proof that you can’t perform your “own occupation,” make sure your doctor’s statement addresses that—not just that you have a diagnosis.

Need Help Understanding Your Policy?

If you’re not sure how your LTD policy defines disability—or how to prove you meet the definition—we’re here to help. Our firm has experience reviewing complex insurance policies and preparing appeals that demonstrate that our clients meet the specific requirements of their plan.

Contact us today for a free consultation. We’ll help you make sense of your policy and protect your rights every step of the way. Call (888) 321-8131 to schedule a free case evaluation today.