The words “own occupation” are not the whole contract

What the lesson covers

1. 01

   The client

   Doctor Chen is a surgeon. A hand injury means she can no longer operate. She can still teach, so she takes a part-time teaching job. Her policy says own occupation. Does the benefit keep coming while she teaches? The answer depends on one clause in the definition.

2. 02

   Three definitions

   Under a pure own-occupation definition, she is disabled if she cannot perform the important duties of her own occupation. Income from other work does not matter. Under a regular-occupation definition, she must be unable to do her own occupation, and also not be working elsewhere. Teaching ends the benefit. An any-occupation definition asks whether she can do any job suited to her training and experience. Many policies switch to it after a set period, often two years.

3. 03

   Read it all

   Same injury, same teaching job, two different contracts, and two different results. So read the whole definition: the occupational test, any condition about other work, and whether the definition changes later.

4. 04

   Exam move

   Here is how the exam asks it. Hospital confinement? No. That has no place in the definition. Accidents only? No. Both definitions cover illness and accident alike. Only after the full benefit period? No. The definition applies from the start of the claim. Unable to perform his own duties, and not working elsewhere. That is the answer.

5. 05

   Takeaway

   Remember the difference in one line: regular occupation adds, and not working elsewhere. Base any recommendation on the actual contract wording and the client’s work.