Many of the definitions in the SPD are such a catch 22, as the wording contradicts prior defining statements and continuous following other statements make it impossible according to these terms, to have an OWN OCCUPATION
Define gainful occupation according to your policy terminology:
Means any occupation in which the insured employee is or could reasonably become qualified considering his or her education, training, experience, mental and physical abilities, could reasonably find employment, considering the demand in the national labor force and could or reasonably expect to earn a before tax income at least equal to 60% of his or her predisability income within 12 months of returning to work.
(Main duties or material or substantial duties):
means those job tasks that are normally required to perform the insured employees own occupation and could not reasonably be modified or omitted. To determine whether a job task could reasonably be modified or omitted the company will apply the american with disabilities act( ADA) standards concerning reasonable accommodation. It will apply the acts standards, whether or not, the employer is subject to the act or the insured employee has requested such a job accommodation, an employers failure to modify or omit other job tasks does NOT render the insured employee unable to perform the main duties of the job.
Main duties include those job tasks as described in the U.S department of Labor dictionary of occupational titles and as performed in the general labor market and national economy. Main duties are NOT limited to those specific job tasks as performed for a certain firm or at a certain work site.
(Own occupation or regular occupation)
means the occupation, trade or profession in which the insured employee was employed with the employer prior to disability and which was his or her main source of income prior to disability. It means a collective description of RELATED jobs as defined by the U.S department of labor dictionary of occupational titles. It includes ANY work in the same occupation for pay or profit, regardless of whether such work is with The employer, with some other firm or self employed or whether a suitable opening is currently available with the employer or in the local labor market.
Totally disabled or total disability:
will be defined as follows, during the elimination period and own occupation period it means that due to sickness or injury the insured employee is unable to perform each of the main duties of any gainful occupation. The loss of a professional license, occupational license, or certification, or a drivers license for any reason does NOT by itself constitute total disability.