The answer to sometimes and depends on context. The question came up in a case before the Sixth Circuit, the federal appeals court covering Kentucky, in the case, Leonor v. Provident Life.
The insured was dentist, and he listed dentistry as his occupation when he bought the disability insurance policies from Provident Life. He also owned a managed other dentistry practices and held substantial investments, his activities in those areas yielding about one-third his annual income.
Disability insurance coverage was triggered, the policy stated, if the insured was by reason of sickness or illness "unable to perform the duties of your occupation." The insurance coverage, Provident, argued that this meant "all the important duties" of Leonor's occupation. But whether or not it did depended on context the Court observed and this ambiguity favored the insured:
The policies’ definition of Total Disability is ambiguous and can reasonably be understood to cover an injury that prevents the insured from performing most, if not all, of the important duties of her pre-injury occupation. This is all that Leonor needs to show in order to prevail.
An important factor in this case was that Leonor bought the insurance himself individually and directly from the insurance company. This meant that ordinary contract law applied, which under Michigan law involved in this case, and dictated that ambiguities be resolved against the insurance company and in favor of the insured. Kentucky law is similar in this respect. Most disability insurance policies are obtained through the insured's employment and include language granting the policy administrator discretion to construe the policy, which shifts the tilt in favor of the insurance company.
Lexington, Kentucky disability insurance lawyer Robert Abell helps individuals and insureds to recover the insurance coverage benefits they have paid for; contact him at 859-254-7076.
