Employees in Chicago with claims for long-term disability benefits are often familiar with the transitional definition of disability in most plans. At first, the long-term disability plan will pay benefits for being disabled from your own occupation, or regular occupation. Then, after some period such as 24 months, the definition of disability will change to being disabled from any occupation, or any gainful occupation. But there is a divergence in policies between whether you must currently possess the qualifications for a substitute occupation, or you may reasonably become qualified for the occupation. This subtle distinction can make all the difference between getting continued long-term disability benefits approved or denied, as demonstrated in a recent case.
In Walker v. AT&T Benefit Plan No. 3, No. 22-55450, 2003 WL 3451684 (9th Cir. May 15, 2023), the long-term disability plan provided disability benefits if the claimant is unable to perform “any occupation or employment for which [they] are qualified or may reasonably become qualified, based on training, education or experience.” Walker was awarded Social Security Disability benefits, but the long-term disability plan denied his claim, identifying several other occupations Walker could perform within his restrictions and limitations, and for which he could reasonably become qualified. After unsuccessfully appealing, Walker sued under ERISA § 502(a).
The United States Court of Appeals for the Ninth Circuit affirmed the district court ruling against Walker. The reasoned that although Walker was awarded Social Security Disability benefits, the Social Security Administration rules require a claimant already possess the qualifications to perform a substitute occupation, where the long-term disability plan merely requires the claimant “may reasonably become qualified.” Walker did not demonstrate he could not become qualified for any of the occupations the long-term disability plan identified, and thus upheld the ruling against him.
If you have a claim for long-term disability benefits, contact a skilled ERISA long-term disability lawyer today.