Own Occupation and Any Occupation
Own Occupation and Any Occupation are legal tests under which a person’s entitlement to disability benefits is assessed. It is important to remember that these are legal determinations. Being totally disabled has different criteria in medicine than it does in disability law.
The majority of long-term disability plans start with a period of own occupation. This period most commonly runs for 2 years. The courts have defined own occupation as meaning the inability to do the essential duties of one’s own occupation.
Some policies will have different terms such as material duties, important duties, or substantial duties in place of essential but the concept is the same – if a person cannot perform the main requirements of their job, then they would be disabled under the terms of the disability policy.
The courts have also clarified that the inability does not have to be total; the courts have used a reasonable person test where one is disabled if returning to work either prevents the person from getting better or actually causes harm to the person. In Paul Revere Life Insurance Co. v. Sucharov (Supreme Court of Canada – 2 SCR 541), the Court recognized that a claimant is totally disabled from performing his work as such when he is unable to perform substantially all of the duties of that position.
The primary issue at the Supreme Court was whether the plaintiff’s ability to do most of his duties on an individual basis but not able to do them collectively meant he was not disabled under the “own-occupation” definition. What was interesting in that case was the wording of the own-occupation definition which used the Insured is completely unable to engage in his regular occupation.
In analyzing the issue, the court then quoted with approval from Couch on Insurance (1983), 2d (Rev. ed.): Page 53:118:
"The test of totally disability is satisfied when the circumstances are such that a reasonable man would recognize that he should not engage in certain activity even through he literally is not physically unable to do so. In other words, total disability does not mean absolute physical inability to transact any kind of business pertaining to one’s own occupation, but rather that there is a total disability if the insured’s injuries are such that common care and prudence require him to desist from his business or occupation in order to effectuate a cure; hence, if the condition of the insured is such that in order to effect a cure or prolongation of life, common care and prudence will require that he cease all work, he is totally disabled within the meaning for health or accident insurance policies."
The Court recognized that without a reasonable component to the disability evaluation, it would be practically impossible to prove that one could not do all duties of a job. For example, if a construction work still has the ability to write but not lift a hammer, does that mean the person does not qualify for disability benefits because they are able to do some of their job such as writing down measurements or numbers? Without a reasonable requirement, there is an argument the person is not disabled unless they are literally in a coma.
Simply put, if your limitations - either physical or mental - are preventing you from doing the important aspects of your job, then you are disabled for the purpose of disability benefits.
The above is a brief and very general overview of the meaning of Own Occupation in the disability law context. There are many other considerations that will be covered in other blogs. For questions related to all aspects of disability law, please contact Ludwar Law and we will be happy to assist you.
Please note our practice is primarily limited to group and private disability litigation.