His Disability Policy Looked Fine — Until a Claim Tested It [Podcast] cover art

His Disability Policy Looked Fine — Until a Claim Tested It [Podcast]

His Disability Policy Looked Fine — Until a Claim Tested It [Podcast]

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 I went into this conversation expecting to talk about claims the way most people imagine them: paperwork, delays, frustration, maybe a denial that needs to be appealed. What I didn’t expect was how quickly the discussion shifted to something more unsettling—the realization that many people buy disability insurance believing they’re protected, only to discover years later that the policy language quietly gives the insurer a way out. In this episode of The Income Protection Journal Podcast, I talk to Mark DeBofsky, an ERISA litigation attorney with more than four decades of experience challenging insurer and plan-administrator benefit denials, is the principal of DeBofsky Law Ltd. and a frequent author, congressional witness, and adjunct law professor on disability and insurance law who has litigated disability claims in federal courts, including cases that helped shape how insurers define disability in the first place. His vantage point is different from brokers, carriers, or consultants. He sees policies only after they’re tested—when income has already stopped, work has already changed, and assumptions collide with contract language. The perspective changed everything. When disability policies get tested There’s a point in many careers when insurance decisions fade into the background. Policies are purchased early, premiums get paid automatically, and life moves on. What came through clearly in this conversation is how dangerous that quiet period can be. Mark Debofsky kept returning to the same idea: disability insurance rarely fails in dramatic fashion. It fails through definitions—through terms that sound reassuring when a policy is sold and become restrictive only when a claim is filed. One case he described has stayed with me. A dentist believed he had own-occupation coverage. When a medical condition limited his ability to practice dentistry full time, he adapted. He taught part time. He earned less than half of what he once made. And then the insurer denied his claim anyway. The denial wasn’t based on medicine. It was based on a single word. The policy said “own occupation,” but it also said benefits wouldn’t be paid if the insured was engaged in another “gainful occupation,” according to DeBofsky. The policy never defined what “gainful” meant. The insurer did—after the fact—by deciding that any work paying more than the median wage in the state disqualified the claim. Hearing that logic explained out loud, in real time, lands differently than reading a summary, DeBofsky said. There’s a moment in the audio where you can hear how routine this kind of reasoning has become inside claims disputes—and how jarring it still sounds when you step back and listen to it. Why true own-occupation isn’t just a checkbox We spent a lot of time talking about own-occupation coverage, not as a feature list, but as something that behaves very differently once a claim is underway. Mark made a distinction that often gets lost in sales conversations. A true own-occupation policy pays benefits if you can’t perform your occupation, even if you go on to work elsewhere and even if you earn significant income doing so. Many policies marketed as own occupation quietly reduce benefits once the insured earns income in another role, reclassifying the disability as partial. That distinction matters most for specialists—surgeons, interventional physicians, dentists, litigators—whose skills don’t transfer cleanly. A minor hand tremor can end a surgical career. A cognitive impairment can derail a trial attorney. In those situations, the ability to pivot shouldn’t come at the cost of losing benefits, but in many policies, it does. What’s striking in the conversation is not just the rule itself, but how often professionals don’t realize which version they bought. Mark talks about this without exaggeration. You can hear how frequently he encounters policies that look protective on paper and behave very differently in practice. Group coverage and the illusion of security Another assumption we challenged in the episode is the idea that employer-provided disability coverage is “good enough.” I hear this constantly from high-income professionals: I have a solid group plan through work. I’ll be fine. What Mark DeBofsky describes is a different reality. Group disability policies are designed to protect salary at a moment in time, not long-term earning power. They usually replace a percentage of income up to a cap, integrate with Social Security Disability, and often switch to an any-occupation definition after a limited period. For high earners, that structure creates gaps that aren’t obvious until work stops. There’s a moment in the conversation where we talk through how insurers decide what “any occupation” means—using vocational assessments and transferable skills analyses that often rely more on internal guidelines than on treating physicians’ opinions. Listening...
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