– Weitzenkamp v. Unum Life Ins. Co. of Am., 661 F.3d 323, 330 (7th Cir. 2011).
Whether you are just contemplating applying for short-term or long-term disability benefits, or your benefits have been denied or terminated, you probably have some questions about the process. After all, how does one prove disability? And how can you get your claim approved at the initial application stage, without having to go through an appeal or litigation? This page will take some of the guesswork out of the process.
A Diagnosis Is Not a Disability
To succeed in your disability claim or appeal, it is crucial that you first recognize that a diagnosis is not a disability. In most disability cases, the existence of the medical condition itself is not in dispute; rather, what is disputed is whether the condition produces symptoms of such severity that the claimant is precluded from working.
The next step is to identify the ways your medical condition limits or restricts you from working. Specificity here is important. A statement from your doctor that you are “unable to work,” without explaining why, is generally insufficient to receive disability benefits. Rather, your doctor must identify concrete restrictions and limitations that are consistent with the medical evidence and would preclude you from performing your former occupation or another occupation. Examples of restrictions and limitations include:
- The inability to keyboard on more than an occasional basis due to carpal tunnel syndrome;
- The inability to maintain the attention, concentration, and pace necessary to perform skilled work due to anxiety and depression;
- The inability to tolerate sitting on more than an occasional basis due to pain and the need to switch positions, due to low back pain;
- The inability to learn and remember detailed or complex tasks due to a cognitive disorder secondary to stroke.
Note that some of the forgoing restrictions and limitations are “exertional,” meaning they relate to your strength (i.e., how far you can walk, how much weight you can carry, etc.), while others are “non-exertional,” meaning they do not relate to your physical strength but nonetheless impact your ability to perform your material job duties. Examples of non-exertional limitations that can interfere with your ability to work include excessive absenteeism, the need for unscheduled breaks, and being “off task” due to symptoms or medication side effects.
Disability Is Contextual
When pursuing disability benefits, it’s important to remember that medical evidence is only part of the equation: you must also be aware of the material job duties of the occupation (or occupations) that the STD or LTD plan has alleged you can perform. You must then identify the ways in which your restrictions and limitations preclude you from performing those occupations.
If, for example, your doctors have restricted you from driving, but you are not required to drive for your job, then that restriction is irrelevant to your disability claim (and, no, the inability to drive to and from work is unfortunately not relevant for the purposes of determining disability).
The material duties of your job may not be immediately apparent to your STD or LTD plan administrator. Thus, it can be helpful to provide the plan with a copy of your job description to ensure that all aspects of your former occupation are taken into account. Similarly, your background, education (or lack thereof), and work experience are relevant to determining what other occupations you can perform.
In summary, context is important. The existence of an illness or injury, alone, is not usually sufficient to establish disability. Rather, your doctors must provide concrete restrictions and limitations that form a logical nexus with the material duties of your former occupation or another occupation the plan administrator has alleged you can perform.
What Conditions Can Be Disabling?
- Arthritis and Degenerative Joint Disease
- Back and Neck Pain
- Blood and Clotting Disorders
- Brain Tumor and Stroke
- Cardiac Disabilities
- Cognitive Impairment
- Long COVID
- Digestive Disorders
- Fibromyalgia and Chronic Fatigue
- Head Injury & Post-Concussive Syndrome
- Hearing & Balance Disorders
- Autoimmune Disorders
- Mental Health Disability
- Migraine Headaches
- Neuro Degenerative Disease
- Peripheral Neuropathy and Carpal Tunnel Syndrome
- Pulmonary Disorders
- Vision Impairment
Does This Apply to You?
Contact DeBofsky Sherman Casciari Reynolds P.C. for an attorney consultation. We will work with you to figure out your problem, and how we can help.
Why Hire a Disability Lawyer?
As you can see, short-term and long-term disability cases are complex. These cases often require the involvement of an experienced benefits attorney to ensure that the claimant gets the benefits he or she was promised. Disability insurers are profit-driven corporations, and they have been emboldened by decades of court precedents that have eroded the deterrents to insurer misconduct and bad faith.
Although you don’t need to hire a lawyer to assist you with applying for short-term or long-term disability benefits, it certainly cannot hurt, and it can prevent problems down the road. For instance, an attorney can identify and navigate around coverage issues and problematic policy limitations. An attorney can also offer advice on how to approach conversations about
Finally, if your short-term or long-term disability claim has been denied, you should strongly consider hiring a lawyer to handle the appeal. Most lawyers who concentrate in this area offer contingency fee arrangements such that there is no cost to you unless the appeal is successful (except for out-of-pocket costs, such as for medical records). Oftentimes, courts won’t allow claimants to supplement the evidence submitted during the pre-suit appeals process in litigation. Thus, engaging a lawyer to handle your appeal will not only maximize your chances of winning the appeal but also put you in the best possible position should your case go to litigation.
“You were the hardest working and most compassionate Attorney I have ever worked with.”
Sally G| Client
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