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The Own Occupation Illusion in Long Term Disability Insurance Cases

Many of our client’s think that they are entitled to Long Term Disability Insurance benefits because they are no longer able to do their job as a result of an illness or injury.  What they don’t understand is that the Disability Insurance companies have fabricated a hurdle that can  sometimes be impossible to clear.  A recent case out of Florida provides a good illustration.  In McCook v Aetna the court rejected the claim finding:

“Aetna was entitled to rely on the Dictionary of Occupational Titles (“DOT”) to determine how McCook’s occupation was normally performed in the national economy. See Cook v. Standard Ins. Co., No. 6:08-cv-759- Orl-35DAB, 2010 WL 807443, *9-10 (M.D. Fla. Mar. 4, 2010) (stating that defendant “was entitled to rely on the DOT’s classification exclusively” for its “own occupation” determination, where the plan allowed defendant to “look at the way the occupation is generally performed in the national economy”). The Court agrees with the findings of the Magistrate Judge which conclude that “[t]he additional duties and demands described by Plaintiff appear to be products of her particular work setting at [Bank of America], not her occupation as generally performed in the national economy.”

Basically, the court agreed with Aetna that because of how the plan defined  “Own Occupation” the disability insurance company could just ignore the claimant’s actual job duties for her employer.  This is a good example of why  it can be critically important to understand how the insurer may attempt to re-characterize your occupational duties in a Long Term Disability Insurance claim.