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‘Any Occupation’ Test for Long Term Disability Benefits

by | Worker’s Compensation

If you are applying for workers’ compensation benefits, it is recommended that you use the services of a South Dakota workers’ compensation lawyer. However, it’s also important to learn about various topics, including the “any occupation” test. 

The “any occupation” test is used for cases of long-term disability benefits. Its purpose is explained here. 

Any Occupation Explained 

The definition of “any occupation” when it comes to disability states that they are only awarded if a sickness or injury impacts the person’s ability to work in any occupation they are qualified for. This depends on the person’s previous experience and level of education. Usually, this test becomes a governing test after a period of two years of the disability that determines if the person will still qualify to receive benefits. 

There are two factors that the court will look at when considering any occupation provision. The first is that the injuries of the insured must be looked at overall and as a whole. What this means is that if the person is not experiencing physical injuries, it should not be assumed that they can return to work by ignoring the cognitive or emotional problems they are dealing with. 

The court is also going to consider if the occupation is something the individual is reasonably qualified to take. For example, someone who worked as a CEO can’t be denied benefits because they could work as a telemarketer. The court is going to consider if the employment in question is reasonable by looking at the type of job, duties, and compensation that is offered compared to the work the individual did when the workplace accident occurred. 

Any Occupation vs. Own Occupation 

If you have a policy that has the provision of “own occupation,” then you may be able to qualify for benefits if the sickness or injury impacts the ability you have to do some of your own duties or tasks. The provision is more lenient because it looks at the person’s ability to do their job. Unlike any occupation, which is more challenging to meet, interpreting the own occupation clause is typically clearer. 

Why Legal Help Is Necessary

If you are in a situation where your benefits are denied because of your inability to pass these tests, you should seek an independent evaluation to ensure that your rights are protected. Some insurers will terminate your benefits unfairly or with no real justification because the any occupation provision is interpreted much too narrowly. 

The judge is also going to consider other factors when looking at the any occupation provision. One thing the judge will consider is if there is work available for the insured party, the amount of compensation they will likely earn, and their overall state of mental well-being. 

It’s important to remember that workers’ compensation laws can be complex. Because of this, you need the services of a long-term disability attorney. They can ensure that you are working with the right doctors and healthcare experts and gather the needed evidence to support your claim that you cannot work. 

Policies with a Hybrid Disability Definition 

Sometimes, insurance policies include a “hybrid” definition of disability. What this means is it will combine some aspects of the own occupation and any occupation provisions. Usually, the policies that do this let the insured provide proof they are unable to work in their occupation for a certain amount of time. After this point, it’s necessary to prove they are unable to do any other type of occupation. 

An example of this is if the insured person has found a new job or occupation. In these cases, their earnings are able to be reduced from the amount of their benefits. An example would be if someone working as a bank teller received a benefit amount of $8,000 a month and started a new job as a retail store clerk where they received $6,000 per month. In this case, the new benefit amount would be reduced by $2,000 if they had one of these hybrid policies. 

It is important for the insured party to understand how the definition of a disability can shift with a hybrid policy. Usually, the period for this is 24 months. It’s important that, before this amount of time passes, for the insurer to review the file to see if they are still qualified for the same amount of benefits based on the hybrid definition explained here. Sometimes, a person receiving long-term benefits may have them terminated if the disability definition shifts. 

When Does the Definition of Disability Shift?

Employees may be considered to be disabled if their illness or injury keeps them from:

  • Performing the material duties of their regular occupation
  • Cannot earn at least 80% or more from their regular occupation

After one year (or 12 months based on the hybrid definition) passes, the employee will only be classified as disabled if the sickness or injury keeps them from:

  • Performing the material duties of the occupation, they could be qualified based on experience, training, or education
  • Cannot earn at least 80% of their indexed earnings

What this illustrates is if you have a hybrid policy, you have to prove that you can’t perform any occupation again that you may be considered reasonably qualified for based on your experience, training, or level of education. 

How a Workers’ Compensation Attorney Can Help

There’s no question that workers’ compensation laws can be challenging to understand. There are also many requirements and stipulations that must be known and adhered to. Because of all the issues that can arise with these cases, it is best to let a workers’ compensation attorney help with your case and situation. They can review what is going on and ensure that your rights to benefits are protected. 

If you are injured or ill, you may not be able to work in the same job you once had, or at all. In these situations, you should receive benefits. If you have been denied or just have questions, get in touch with us today. 

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