Importance of Getting a Vocational Opinion in Long-Term Disability Claims

Employees in Chicago with claims for long-term disability benefits are usually unaware of the vocational aspects of long-term disability claims, whether the definition of disability is based on your own occupation or any occupation. It’s especially important in the own occupation stage, where insurance policies expressly distinguish between your job duties and duties of the occupation as it is performed in the national economy. For instance, if your job requires you to work 12-hour shifts, is that job specific or indicative of how the occupation is generally performed? The best way to answer that question is through a vocational expert hired to render an opinion in support of your long-term disability claim. A recent case demonstrates the risk of not getting a vocational opinion in support of your long-term disability claim.

In Artz v. Hartford Life & Accident Insurance Co., No. 21-cv-0391, 2023 WL 3752006 (E.D. Wis. June 1, 2023), Artz suffered from Multiple Sclerosis and worked as a senior electric distribution controller for an energy company. His job required he work one week of 12-hour shifts during the day, followed by one week of 12-hour night shifts. In 2019, Artz’s Multiple Sclerosis fatigue worsened to the point he could no longer perform his job, and he claimed short-term disability. Hartford approved the short-term disability, but upon transition to long-term disability, Hartford denied the claim, asserting Artz could work 8 hours a day, 40 hours a week. Hartford utilized its own vocational expert to opine the occupation, as it is performed in the national economy, does not require working in excess of 8 hours per day. Hartford denied the claim, and invited Artz to submit any additional materials with his appeal. When Artz appealed, he supplied no additional information, but asserted the nature of the job requires working however long it takes to resolve electrical outages. After Hartford upheld its denial on appeal, Artz sued under ERISA § 502(a).

The United States for the Eastern District of Wisconsin upheld Hartford’s decision under the deferential “arbitrary and capricious” standard of review.  It reasoned that Hartford provided multiple medical opinions opining Artz had capacity to work 8 hours per day for a full work week, and a vocational opinion that the occupation only requires working 8 hours per day. Artz argued his job duties should be taken into account in defining the occupational duties, but the court determined Artz provided no evidence the occupation, as it is performed in the national economy, requires working over 8 hours per day. If Artz were correct about the nature of the occupation, a vocational expert opinion could have established that, but Artz failed to submit any additional materials with his appeal. Based on the record, the court concluded Hartford had a rational basis for reaching its decision, and the court ruled in Hartford’s favor.

If you have a claim for long-term disability, contact a knowledgeable ERISA long-term disability lawyer today.