Are you a professional, tradesman, or “knowledge worker” who needs to submit a disability insurance claim or has been denied disability benefits? You are not alone. Only one third of American workers have long term disability insurance, and far fewer have individual disability insurance policies. Those who have disability coverage tend to be professionals, tradesmen, and so-called “knowledge workers” who are paid to think for a living. The forgoing occupations require years of training and education and are well-paid, which is why workers are reluctant to leave them to go on disability. If the disability claim is denied, it only adds insult to injury, causing claimants to feel that their credibility is in doubt when they are still mourning the loss of a career.
The process of applying for and appealing the denial of disability benefits can be opaque and overwhelming. At DeBofsky Law, we have experience helping professionals and others navigate the often-opaque process of applying for disability benefits and appealing the denial of disability benefits. Using the law and vocational resources, we ensure that your occupation is properly defined. We then gather medical and opinion evidence to prove you are unable to perform that occupation. We have assisted thousands of individuals like yourself to obtain their rightful benefits.
How Disability Insurers Define “Occupation”
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 Insurance Co., 783 F.3d 374, 381 (1st Cir. 2015) (citation omitted)
Most group and individual disability insurance policies define “disability” as the inability to perform the material duties of your “own occupation” and earn a percentage of your pre-disability income. (After 24 months, most group LTD policies transition to an “any occupation” definition of disability.) To prove you are unable to perform your own occupation, you must first establish what that occupation is. Often, this can be accomplished by submitting a copy of your job description. But what if your job description is vague, or perhaps you were never provided one? In such instances, you may need to get creative. You can prepare a narrative statement outlining your job duties, ask your supervisor to prepare one, and/or submit the original job posting as evidence of the job requirements.
Most long term disability plans utilize an objective standard for determining a claimant’s occupation that looks at how the occupation is performed in the national economy. (In contrast, most short term disability plans and individual disability insurance policies utilize a subjective standard that considers how the occupation was performed for a specific employer at a particular location.)
To determine how an occupation is performed in the national economy, the LTD plan administrator compares the claimant’s job description against standardized vocational resources such as the U.S. Department of Labor’s Dictionary of Occupational Titles. In the process, disability insurers will often manipulate job titles and duties to make it appear that the claimant’s occupation is less physically or mentally demanding than it is. The attorneys at DeBofsky Law are experienced at recognizing and averting this trap.
Don’t Let a Denied Claim Add Insult to Injury, Let Us Help You Get the Benefits You Deserve
Qualitative vs. Quantitative Disabilities
Disabilities can be divided broadly into two categories: qualitative and quantitative. The distinction was first explained by the Seventh Circuit in McFarland v. General American Life Insurance Co., 149 F.3d 583, 588 (7th Cir. 1998). A qualitative disability is one that precludes the employee from performing one or more material duties of his or her occupation. Id. An example is a baseball shortstop who can run and catch but can no longer throw. Id. Another example is a surgeon who can examine patients, make diagnostic recommendations, and type up notes, but who can no longer operate, for example due to an essential tremor.
In contrast, a quantitative disability that impacts the amount of work a person can do or the duration a person can work, but does not prevent him or her from performing any one particular task. Id. An example of a quantitative disability is a salesman who is able to perform all of the material duties of his job, but whose output is reduced to 25% of his previous sales due to an illness or injury.
A disabling condition may be both qualitative and quantitative. For example, a lawyer with a visual impairment might be unable to proofread documents (a qualitative disability, since proofreading is a material duty of the job) and suffer a 75% reduction in productivity due to difficulty reading and responding to emails and other written communications (a quantitative disability, since it impacts output).
Does This Apply to You?
Contact DeBofsky Law for an attorney consultation. We will work with you to figure out your problem, and how we can help.
Get Experienced Benefits Legal Representation by Your Side
Whether your disability is qualitative, quantitative, or both, the exprienced disability lawyers at DeBofsky Law represent various occupations. We can help you to frame your case in a compelling manner to improve the chances of your claim or appeal being approved, or to persuade a court or jury that the denial of benefits was unjust. We are a national firm and represent professions throughout the United States, with physical offices in Chicago and Seattle. Get in touch, we help you get the benefits you’ve earned through your hard work and dedication
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