An 'own occupation' disability income policy pays benefits when the insured:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
An own-occupation definition of disability is the more favorable test for the insured: benefits are payable when the insured cannot perform the material and substantial duties of his or her own occupation, even if the insured is capable of, or actually performs, another occupation. This is a common definition for professionals and highly trained workers, since a surgeon unable to operate could still work in teaching yet remains eligible. The alternative, any-occupation, requires inability to perform any occupation for which the insured is reasonably suited. The distinction between own-occupation and any-occupation definitions is a core disability provision (AH-IV.9).
Why the other options are wrong
- B) This describes the any-occupation standard, which is a stricter test requiring the insured to be unable to perform any occupation for which he or she is reasonably suited by education, training, or experience. The own-occupation definition is more favorable because it looks only at the insured's own job.
- C) Injury alone is insufficient to trigger benefits under an own-occupation policy. The disability must prevent the insured from performing the material and substantial duties of his or her own occupation, so a minor injury that does not interfere with work pays nothing.
- D) A diagnosis without a loss of work capacity does not trigger benefits. The own-occupation policy tests the ability to perform occupational duties, so a chronic illness that does not affect the insured's ability to work would not qualify.
Memory hook
Own-occ: can't do my job, benefits pay, even if I find another.