"Own Occ" versus "Any Occ"
There are two main types of disability coverage. The first, known as "own occupation" coverage, provides benefits if the claimant cannot perform the material duties of his or her own occupation. Therefore, if a concrete worker can no longer lift heavy weights due to a severe back injury, he would likely qualify for disability benefits under this type of coverage. He would be unable to perform his "own occupation."
The other type, known as "any occupation" coverage, generally affords benefits if the claimant cannot perform any occupation for which he or she is reasonably suited given his or her education, background, and experience. This definition of disability is similar to the one used by the Social Security Administration. It is often more difficult to satisfy the "any occupation" definition of disability.
To obtain disability benefits, a claimant must satisfy the particular definition of disability set forth in the policy. Different policies contain different definitions, so it is important to determine the applicable definition early in the claims process.
In many policies, the definition of disability changes after a certain period, typically 12 or 24 months. In those policies, the claimant is initially entitled to disability benefits under the "own occupation" standard, but then must satisfy the "any occupation" standard to continue receiving benefits. ERISA plans and policies sometimes pay benefits during the "own occupation" period and then terminate benefits after the change in definition.