The Definition That Decides Your Claim
Disability policies do not ask whether you are unwell. They ask whether you meet a definition, and which definition applies is usually the most consequential thing in the document.
First: where did your coverage come from?
If this coverage came through an employer, federal law may govern it — which changes your appeal rights, imposes deadlines that are strict, and can displace the state remedies described here. Establish that before deciding how to fight a denial.
Two very different standards
An own-occupation policy asks whether you can perform the material duties of your own job. An any-occupation policy asks whether you can perform any job you are reasonably suited to. The second is far harder to satisfy, and a claimant can plainly meet the first while failing the second.
The switch that catches people out
Many group policies apply the own-occupation standard for an initial period — commonly around two years — and then switch to any-occupation. Claims paid without difficulty for two years are frequently terminated at exactly that point, and the termination reflects the changed definition rather than any change in the claimant's health.
What the argument actually requires
Under own-occupation, evidence of what your job actually demanded — not the title, the duties. Under any-occupation, it becomes a vocational question as much as a medical one, and vocational evidence matters as much as the treating physician's opinion.
What you can do about it depends on your state
This describes the denial itself, which works much the same everywhere. Whether you can sue under a statute, what you can recover, and how long you have differ sharply — choose the state where your policy was issued.
Common questions
They paid for two years and then stopped. What happened?
Frequently the definition changed from own-occupation to any-occupation at that point. The termination reflects the policy language rather than a change in your condition.
What evidence matters most?
Under own-occupation, detailed evidence of what your job actually required. Under any-occupation, vocational evidence becomes as important as the medical evidence.
Is this what happened to you?
A free, confidential review can tell you whether the denial holds up — no cost, no obligation.
Other reasons claims get denied
General information, not legal advice. Insurance law differs by state and every policy is different.