If you are ill or have been injured and can no longer work, disability insurance protects you and your family from financial hardship by paying a portion of your income when you cannot work. The disability benefits claim process can be complicated, particularly when you have to establish that you are disabled from all work, not just your own occupation. All disability insurance benefit claims involve both vocational and medical considerations. Here, we will explore the vocational aspects of a disability insurance benefits claim. We will explain how occupational duties are assessed, and the importance of the Dictionary of Occupational Titles (DOT) within the disability benefits claim process.
What Are Disability Insurance Benefits?
Disability insurance benefits protect your income if you become disabled and can no longer work. While many employers offer disability insurance to their employees, some do not. Many employer-sponsored disability benefit plans will provide short-term disability benefits (STD) for the first three to six months you are out of work, and then long-term disability (LTD) benefits for those conditions and injuries lasting for more extended periods. LTD benefits are typically payable until you reach retirement age. If you are self-employed, work for an employer that does not offer disability insurance, or have disability insurance through your employer, but it covers only a small portion of your income, you can also purchase individual disability insurance on your own.
How Do Most Disability Benefit Plans Define Disability?
Every disability insurance benefits claim involves both a medical and a vocational component. All disability benefits policies also define disability a little differently. Nonetheless, most short-term disability (STD) and long-term disability (LTD) policies initially define disability as the inability to perform the material duties of your occupation due to a psychiatric and/or medical condition. After a period of typically 12, 24, or 36 months, the definition of disability often changes. The insurance company will then consider whether your condition prevents you from performing the material duties of any occupation for which you are reasonably qualified. In contrast, individual disability insurance policies tend to define disability based only on your own occupation and sometimes your particular specialty.
What Is the Difference Between an “Own Occupation” and “Any Occupation” Definition of Disability?
Most group disability benefit plans will first assess your disability based on your inability to perform the material duties of your occupation. In most long-term disability (LTD) benefits plans, the definition of disability will change to an “any occupation” standard after around 12 to 36 months. Under an “any occupation” definition of disability, the insurer and/or plan administrator will consider your education, training, and work history to assess whether there are other occupations you can reasonably perform.
Some disability benefit plans will also include an earnings qualifier in the definition of disability, which requires that the insurer and/or plan administrator consider your earnings potential in other occupations in relation to your pre-disability earnings. In that case, your disability insurance benefits cannot be terminated at the “any occupation” stage unless it can be established that you would be able to earn at least a minimum percentage of your prior earnings in other occupations.
How Are Vocational Duties Assessed for a Disability Insurance Benefits Claim?
There are a few different sources that insurers and/or disability plan administrators consider in assessing the vocational aspects of your disability benefits claim. At the “own occupation” stage, the insurer and/or plan administrator should review a summary of your material job functions, your job description, and potentially also your resume. Nonetheless, most group disability benefit plans define disability at the “own occupation” stage as the inability to perform your occupation as it is generally performed in the national economy. It will not consider your specific job duties for your particular employer.
As a result, when assessing occupational duties on a national basis, under both the “own occupation” or “any occupation” definitions of disability, disability insurers and/or plan administrators often use standardized occupational databases to characterize the material functions of jobs. The most commonly used vocational database is the Dictionary of Occupational Titles (DOT). Because the DOT was last updated in 1991, the Occupational Information Network (O*NET), an online vocational database, may be used as well.
What Is the Dictionary of Occupational Titles?
The United States Department of Labor first published the Dictionary of Occupational Titles (DOT) as a nationally standardized job database in 1939. The DOT has since been updated four times, with the latest edition being released in 1991. The DOT documents the physical and mental/cognitive demands of various occupations, along with the required training/educational background and a general description of the material duties. The DOT categorizes jobs into the following exertion levels based on how physically demanding an occupation may be and how much physical strength is required to perform it:
- Sedentary – involving mostly sitting and lifting up to 10 pounds
- Light – involving lifting up to 20 pounds
- Medium – involving lifting up to 50 pounds
- Heavy – involving lifting up to 100 pounds
- Very Heavy – involving lifting up to 100 pounds
The DOT can be a helpful resource in assessing disability insurance claims. The DOT has also received criticism in recent years because it has not been updated in over 20 years. The DOT has thus failed to keep up with more current changes in the labor market, particularly in the professional services and technological sectors. Finally, the DOT tends to focus more heavily on the physical demands of occupations without providing a detailed assessment of what is often the most demanding aspect, which is the mental/cognitive duties.
How Can an Attorney Assist in Clarifying Vocational Disputes in the Assessment of Your Disability Insurance Benefits Claim?
Many issues may arise in an insurer’s review of your occupational duties and transferability of skills to other occupations that may result in the denial and/or termination of your disability insurance benefits. The insurance company may rely on the Dictionary of Occupational Titles (DOT) to only assess the physical demands of your job, while disregarding the more demanding cognitive elements. The DOT also may not adequately document your specific occupational duties.
If you are no longer able to work, it is critical that you receive your disability benefits without interruption, so you can continue to meet your financial obligations. You do not want to let a dispute about your vocational background, occupational duties, and/or transferability of skills to other occupations impact your benefit payments. The benefits attorneys at DeBofsky Law can help you navigate and clarify any vocational disputes that may arise during the evaluation of your disability insurance benefits claim. Contact us today.