If you have been prevented from working due to an injury or illness, you may be eligible to receive Short Term Disability (“STD”) and/or Long-Term Disability (“LTD”) benefits. These benefits usually come from your employer’s insurer, however, private disability benefits can also be purchased for those who are self employed. The range you can expect to receive in STD/LTD benefits is typically anywhere from 65-80% of your weekly salary.
To be eligible for STD benefits, you need to provide medical documentation which demonstrates that you are unable to perform the essential duties of your own occupation due to injury or illness. STD Benefits usually provide coverage for a few weeks or months, possibly even one year, depending on the insurance policy.
Once your STD benefit period concludes, you will typically need to apply for LTD benefits thereafter if you want to continue your coverage. The test for obtaining LTD benefits is essentially the same as for STD benefits. You must again prove that your injury or illness is preventing you from performing the essential duties of your own occupation. Unlike STD benefits, LTD benefits provide coverage for an extended period of time. Most insurance policies will cover a period of up to two years if you meet the test. In the legal field, this is often referred to as the “Own Occupation” period, as the test for eligibility in such insurance policies often refers to not being able to perform the essential duties of your “own occupation.”
When the two year “Own Occupation” period is up, the test changes and becomes much more difficult to meet. If an individual wants to continue receiving LTD benefits, they will now have to meet the “Any Occupation” test. There are policies, however, for a higher premium, which have the post-two year test as per your “Own Occupation.”
What does “Any Occupation” mean? In contrast to the “Own Occupation” period, a claimant in the “Any Occupation” period will have to demonstrate that they cannot perform the essential duties of any occupation, not just their own. In the “Any Occupation” period, it does not matter that you cannot do your own job. The insurer may argue that your injuries or illness prevent you from performing the essential duties of your own occupation, but not any occupation. For example, someone’s education, training, and experience in being a doctor would not be relevant to the insurer in this part of the test. In this example, an insurer could argue that this doctor is not prevented from performing any occupation, such as being a Walmart greeter, or a parking ticket attendant. As you can see, this makes it much more difficult to obtain LTD benefits in the “Any Occupation” period as opposed to STD benefits or LTD benefits in the “Own Occupation” period.
LTD benefits usually provide coverage to retirement age if you can continue to prove that you cannot perform the essential duties of any occupation.