A “True Own Occupation” policy is designed to cover the
insured’s occupation at the time they become disabled
and provide the contractually agreed upon benefit
amount. As long as the dentist continues to meet the
policy definition for Total Disability, they can pursue any
occupational venture without jeopardizing their
insurance benefit.
“Modified Own Occupation” Coverage provides a
“Total Disability” benefit, only if a dentist is disabled
from working in their occupation and not working in
“Any Gainful Occupation.” Like “True Own Occupation”
coverage, a dentist is entitled to 100 percent of the Total
Disability benefit, regardless of their ability to work in
another occupation. However, unlike a “True Own
Occupation,” the dentist is no longer eligible for a
“Total Disability” benefit if they choose to engage in
any work activity, regardless of their compensation.
Unless the “Modified Own Occupation” policy contains
a favorable definition for “Any Gainful Occupation”, or
“Residual/Partial Disability” coverage, a dentist is no
longer eligible for disability benefits if they choose to
work in another occupation. These policies are often
confused by dentists as “True Own Occupation” policies.
Mistaking one’s coverage is truly detrimental if a dentist
is under-insured. Moreover, for dentists with the capacity
to work in other occupations, it forces them to choose
between sacrificing their disability coverage and
pursuing meaningful work activity.
“Limited Own Occupation” coverage provides similar
coverage as the “True Own Occupation” policies;
however, this coverage is limited to a specified duration
of time. The duration of coverage is selected by the
dentist at the time of application. Examples include
“24-month” and “60-month” “True Own Occupation”
periods.
The key issue is what happens after the exhaustion
of the “True Own Occupation” period.
Depending on the policy provisions, the policy can:
1. Terminate by its own terms. This is true for policies
that only provide coverage for a set duration of time.
2. Convert from a “True Own Occupation” policy to an
“Any Occupation” definition. If this definition applies,
the insurance company will assess the dentist’s
medical condition and conduct a “Transferable Skills
Analysis” to determine if the dentist is capable of
working in “Any Occupation” based on their
education, training and experience. The insurance
company will terminate benefits if its internal
consultants conclude the dentist has the capacity
work in “Another Occupation”, regardless of actual
employment.
3. Convert to a “Modified Own Occupation” definition
subject to the issues outlined above.
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