Navigating the world of long-term disability insurance can be daunting, especially when it comes to understanding how insurers analyze an individual’s occupation. Your occupation serves not only as a source of income but also forms a part of your identity. When faced with the possibility of being unable to continue working due to a disability, understanding how insurers analyze the material and substantial duties of an occupation becomes crucial. In this article, we will explore the factors insurers consider when evaluating claims and the significance of occupation in the disability insurance claim decision-making process.
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The Crucial Role of Occupation in Disability Claims
In preparing a disability application or appeal, it is natural to focus on the medical evidence. But if the disability policy defines “disability” as the inability to perform one’s own occupation, it’s equally important to define the demands of that occupation. As one court put it, “Let us be perfectly clear: under an own occupation standard, medical evidence is only part of the equation. To assess a claimant’s ability to perform his own occupation, a decisionmaker must be aware of, and apply, the requirements of the occupation.” McDonough v. Aetna Life Ins. Co., 783 F.3d 374, 381 (1st Cir. 2015) (citation omitted).
For that reason, it’s important to submit, along with your LTD claim or appeal, a copy of your job description. If no job description exists, submit the job posting and/or ask your supervisor or human resources person to provide a narrative describing the material demands of your occupation, including the physical demands, cognitive demands, work schedule, and whether driving and/or travel was required. Adequately documenting your job duties at the outset of a disability claim can help to prevent the interruption of your benefits later.
Related Article: The Vocational Aspects of Disability Insurance Benefit ClaimsJob vs. Occupation: Understanding the Difference
Most short-term disability plans or policies define “disability” as the inability to perform one’s own occupation as it is normally performed for the plan sponsor (i.e., the employer). In contrast, most long-term disability insurance policies define “disability” according to a national standard, meaning a person is disabled if he or she is unable to perform his or her own occupation “as it is performed in the national economy.”
To determine how an occupation is performed in the national economy, disability insurers will typically consult a vocational expert who analyzes the claimant’s job duties and identifies a corresponding job title within the U.S. Department of Labor’s Dictionary of Occupational Titles, O*NET, or other vocational resources.
Thus, if you are employed as a nurse primarily in a clerical (i.e., sedentary) capacity, your occupation may nonetheless be categorized as “light duty” by your disability insurer because nursing is considered a light-duty occupation in the national economy. The inverse is also true: if you are employed as a nurse and regularly must lift up to 50 lbs. (making it a medium-duty job), your occupation may nonetheless be categorized as light duty because that is how the occupation is performed in the national economy. (Definitions of sedentary, light, and medium duty can be found here.
How Disability Insurers Game the System
There are limits to how far a disability insurer’s classification of an occupation may stray from the unique demands of a claimant’s job. For example, in Sapp v. Liberty Life Assurance Co. of Bos., 210 F. Supp. 3d 846, 853 (E.D. Va. 2016), the court overturned a denial of disability benefits to a wine salesman (a medium duty occupation) where the disability insurer classified his occupation using the generic job title of “Outside Sales Representative” (a light-duty occupation), observing:
At a certain level, it is easy to generalize any occupation to a level at which it requires only light or sedentary work. In this case, Liberty’s Vocational Expert examined Mr. Sapp’s documents and concluded that he best fell into the category of: “Outside Sales Representative.” At this level of breadth, however, the job title loses much of its descriptive value. For example, it is entirely unclear from this title whether this “occupation” requires sedentary work, such as an employee who sells cards or flowers; or, whether the sales representative is in fact in the business of selling and delivering wine (or refrigerators), which would require considerably more physical effort. Where the expert does not have appropriate documentation, such a broad generalization may be appropriate. When the physical demands are laid out in detail in a nine-page document, however, using this level of breadth constitutes an improperly cursory inquiry into the actual duties of the job.
The Sapp court emphasized that Mr. Sapp’s job duties were outlined in a detailed, nine-page document that Liberty ignored. For this reason, it is important to provide as much detail as possible regarding the material duties of your job, to prevent the disability insurer from attempting to use a more generic or less demanding occupation as the standard for determining disability.
When to Hire a Vocational Expert
While submitting a detailed job description, job postings, and a narrative description of your job duties prepared by your employer will go a long way to resolving any disagreement about your job duties, sometimes it may not be enough. In these instances, it may be beneficial to enlist the services of a vocational expert to help analyze your occupation and explain why you are unable to perform that occupation, given your impairments.
A vocational expert can review the disability insurer’s occupational analysis and confirm whether the occupation identified is the most analogous to the insured’s occupation. Sometimes, the insured’s job cannot be encapsulated by a single occupational title but rather is a hybrid of two occupations (for example, a stock broker who also supervises a team of traders).
A vocational expert can also fill in the gaps left by standard vocational resources. For example, the Dictionary of Occupational Titles does not acknowledge the stress levels of an occupation, outside of highly stressful occupations such as first responders, surgeons, and trapeze artists. A vocational expert can attest to the stress levels faced by a manager or executive, for example, which might be highly relevant in a case involving cardiac impairment or generalized anxiety disorder.
Likewise, the Dictionary of Occupational Titles does not address work schedules, including the need to work overtime, on-call, extra-long shifts, or irregular hours. A vocational expert can draw from resources like the O*NET, Occupational Outlook Handbook, and labor market surveys to expound on whether the insured’s work schedule is typical of how the occupation is performed in the national economy.
Free or Low-Cost Vocational Resources
Unfortunately, vocational reports can cost hundreds, if not thousands, of dollars. That expense is particularly burdensome if you have reduced or no income. Fortunately, there are some free and low-cost resources available. The O*NET and Occupational Outlook Handbook are available online, as is a version of the DOT.
In addition, if you have applied for Social Security disability benefits, regardless of whether your claim has been approved, there is a good chance the SSA consulted a vocational expert at some point regarding your ability to perform your past work. The opinion of an SSA vocational expert is arguably more neutral and authoritative than that of a retained vocational expert. You can obtain your Social Security exhibit file from your lawyer or by submitting a Form 3288 to your local Social Security office and requesting your complete Social Security exhibit file. (If your case was decided at the hearing level, you should submit a request for the hearing audio to your lawyer or to the Office of Disability Adjudication and Review where your hearing was held.)
Lastly, if you have an iPhone, you can download an app, Job Sleuth (presently $99.99), that contains the complete Dictionary of Occupational Titles in a searchable and printable format. While $99.99 is expensive for an app, it’s a worthwhile investment to obtain authoritative and accurate information about your occupation and/or the occupations the insurer alleges you performed.
Conclusion
Long-term disability insurance provides crucial financial protection for individuals who are unable to work due to a qualifying disability. When assessing a claimant’s occupation, disability insurers utilize a national, as opposed to a subjective standard, that looks at how the claimant’s job is performed in the national economy. This can sometimes lead to gamesmanship by the insurance companies, who have a financial interest in watering down the physical and/or cognitive demands of the claimant’s occupation to make it harder for him or her to qualify for disability benefits. For this reason, it’s important to submit a detailed job description along with an application for or appeal of the denial of disability benefits and to enlist the help of a vocational expert if necessary. The lawyers at DeBofsky Law are experienced at utilizing vocational evidence for the advantage of our clients. Call us for a consultation.
