People in Chicago with long-term disability insurance coverage make a common mistake in making their disability claim, or appealing the insurer’s denial. They often do not submit any direct evidence about how their medical impairments relate to the requirements of their occupational requirements. To avoid losing out on benefits to which you are entitled, this is an important step in the process.
Whether the long-term disability policy is an individual policy, or a group policy through your employer enforced under ERISA § 502(a), they share a standard in common. The policies always insure your inability to perform an occupation, whether your own occupation or “any occupation.” The “occupation” is different from a job in that the occupation is a collection of jobs within an occupation. How your job is generally performed in the specified economy will determine the “occupation.”
Insurers will generally ask for your employer’s job description for your position. You may be surprised to see how the job description differs from how you actually perform the job. If there are discrepancies, a detailed statement of what you did will be important to match the job to an occupation. The insurer staffs vocational experts to label your occupation. For varying reasons, they can often misclassify the occupation. Here is a good resource in understanding why. You may need a vocational analysis to correctly determine your occupation to protect your future rights.
You must get direct evidence of how your impairments relate to the occupation’s requirements. Insurers often obtain medical opinions on this issue. At a minimum, you need your physicians to specifically state what you cannot do as it relates to the occupational demands. Insurance forms often do not provide for that direct link. When they do not, you may need to create the evidence, through more appropriate forms for your doctors, or get a functional capacity evaluation or independent medical examination of your own.
This misstep costed a person her long-term disability benefits recently in Kay v. Hartford Life & Accident Insurance Co., No. 19-cv-209, 2021 WL 1378742 (S.D. Cal. Apr. 12, 2021). Kay was an operating room nurse who performed her job at the medium exertion level, but the “occupation” as generally performed was a hybrid of light and medium. Here are good definitions of the difference. She did not submit any direct evidence on how her severe back pain and spine disease, but the insurer got a medical opinion she could meet the physical requirements at the light-to-medium exertion level. Despite crediting Kay’s complaints and medical records, the court determined Kay did not meet her burden of proof.
If your long-term disability claim has been denied, avoid the same missteps by consulting a skilled long-term disability lawyer to give you the best odds of getting your benefits approved.