Insurer Must Consider the Occupation As It Was Performed When Disability Commences

Oftentimes, when reviewing a disability claim, the insurer will not consider how the insured was actually required to perform his occupation. Instead, the insurer, relying on the clause in its policy “the Covered Person’s occupation is as it is normally performed in the local economy” will define “own occupation” solely be reference to how the position could be performed in the local (or national) economy. This issue arises when the particular job requires additional duties such as travel to solicit business as was the case with Polnicky v. Liberty Life Assur. Co. of Boston, 2014 U.S. Dist. LEXIS (N.D.Cal. Nov. 25, 2014). Mr. Polnicky was required to travel out of the office to attend open houses, conduct presentations, deliver loan documents, meet with realtors but Liberty’s vocational case manager determined that the occupation of Reverse Mortgage Consultant could be performed without traveling. The court disagreed with Liberty’s analysis because although it was permitted to consider his occupation as it is normally performed, it must also consider the material and substantial job duties that Mr. Polnicky was required to perform in his position for Wells Fargo.

Insurers cannot agree to provide coverage for an employee’s “own occupation” and then fail to consider the precise elements of the material and substantial duties of the occupation when evaluating a disability claim.
We at Bonny G. Rafel can help if your claim is denied because the insurer does not consider all of the duties of your occupation. Bonny G. Rafel, LLC We advocate for patients with disabling conditions and may be able to assist you in getting the benefits you deserve.

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