What Every Disability Insurance Policy Holders Should Expect When Defining their Occupation
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Disability insurance attorneys Dell & Schaefer discuss the pre-disability occupation duties of the claimant and their impact when seeking LTD benefits.
GREG DELL: Hi, I’m Greg Dell here with attorney Stephen Jessup. And we handle thousands of long-term disability applications for disability claimants across the country. And in this video, I want to concentrate on the importance of clarifying what the occupation is of the claimant, and also how this classification of inability to perform the duties of your occupation, what that really means.
I don’t know if it’s a misconception or whatever, but people call you and they say about this policy to protect my occupation and I can’t do it. And so, therefore, the disability carrier should pay. So let’s focus this on when we’re helping someone to apply for benefits, the first step of what they should expect on the application, in terms of defining the occupation and how we go about presenting the occupation.
STEPHEN JESSUP: Well, first, every insurance company is going to have their own set of forms. They ask questions in similar fashion, but different, because they’re trying to get at different information. That’s going to be based a lot in the language in the policy, especially when it relates to own occupation, any occupation.
But one of the things you really have to look for in a policy is, in defining – a lot of times your own occupation, regular occupation, will be a defined term in the policy – and a lot of times it says how that’s performed in the national economy and not for your specific employer at the specific location you do the job.
So the insurance company is always trying to take a look at not how you really do it, but how random things, such as the Dictionary of Occupational Titles, ONET, or some of these other vocational resources, determine how your job is performed in an ideal situation in the national economy.
GREG DELL: So if we take a person who might be a computer engineer, or a computer consultant, someone who’s doing IT, a very common type of claimant that we would assist with a claim. And they say, OK, I’m an IT person working for this company, and I’m unable to do my job.
Well, the first thing is that the disability insurance company may look at that as IT consultant and they assume that you’re working at a desk. And so talk about how they have these classifications of jobs and why that’s important in how an insurance company looks at it versus how we like to present a claim.
STEPHEN JESSUP: So the Department of Labor has standards. There’s sedentary, light duty, medium, heavy, and very heavy. And a lot of times an insurance company, and especially if your claim has been denied, you’ve seen it where they list what your job is.
Here, it’s an IT consultant. And they may say according – that job is performed at a sedentary level in the national economy. We think you can do sedentary work. Regardless of what the job actually entails we’re going to deny your claim. So it really goes into, and you can sometimes see it in an employer’s job description, the physical-ness of it, where it may go.
Obviously, in IT – when we see our IT guys around here, they’re moving computer equipment, monitors. So there is a level physical-ness. It’s also been out in the field, if you will. IT doesn’t work in a bubble, where they’re sitting at a desk all day at their home facility.
A lot of times they’re out, so there’s the requirement for driving and all that. Where a lot of times, the insurance company will overlook those aspects of the job, and just see it as you sit in a room somewhere and you answer phone calls to do your job.
So we really list out what it entails. It can come from the employer’s job description. But also, I think it’s always important– on the claim forms, they don’t give you a lot of room. So we do attachments and addendums, where we really, with the client, work to list what a typical day may look like, a week, those types of things.
GREG DELL: So what the insurance companies do is they say, OK, we see your job title, without even really digging into what you do for that job. And then they say, OK, that’s usually a sedentary job. And then they look at the sedentary definition from the Dictionary of Occupational Titles, which will basically say the ability to sit for six hours a day, can lift up to 10 pounds, can take – what is it – like, two five minute breaks during the day or something like that.
And then they’ll say to the doctor – they’ll send that Dictionary of Occupational Titles description to a doctor, not anything that has to do with what the person’s job is. Sometimes, they don’t even tell them what the person does. They just say, it’s a sedentary job, do they have any restrictions, limitations stopping them from doing a sedentary job?
And so, then they’ll come back and say – nope, no restrictions with sitting, no restrictions with bending, no restrictions lifting. And the carrier says, OK, you’re not disabled, because you can do a sedentary job.
STEPHEN JESSUP: And also, with that too, that’s assuming that the reason why you can’t work is purely physical. A lot of times there are the cognitive aspects, even with physical claims. Say, this IT consultant went out from a bad back. So they’re going to look at just the physical.
But when you’re in pain or you’re on medication, are your faculties for doing your job there? And this idea with sedentary – because as lawyers, our job’s sedentary.
And anyone who has a sedentary job, in a lot of ways – I joke sometimes. I’m like, if I got paid because I can sit here and lift up to what weighs a gallon of milk, life would be great. But that’s not what work is. So you’re right, they just go to these classifications without really getting into what you do for a living.
GREG DELL: Right, and they don’t – and then it’s like the people deciding the claims forget about what they do every day. Look at even the person who’s evaluating the claim. In a given day, you come in, and you have 10 things you want to get done that day, because they’re reviewing 100 different claim files. Now they’ve got 30 phone calls they weren’t expecting that day.
They’ve got to write up responses to four different appeals. They’ve got to evaluate 10 different applications. They’ve got to review hundreds and hundreds of pages of medical records, and reviews, and read all that. Now assume that person – let’s just go with a neck issue – has neck pain, where if they’re sitting in a position for more than five minutes, their next starts to hurt.
Well, I know, I mean everyone’s sprained their neck or sprained their back. Once that starts bothering you, and the people who are filing claims have that pain continuously, it’s really hard to focus on what you’re doing. Let alone now, you’ve got three different meetings you’ve got to do during the day. You’ve got a checklist of appointments setup.
And what do you do when you’re not feeling well? You’re not focused. I mean, think about common sense, when someone doesn’t feel well just in a social atmosphere, they’re not all there.
STEPHEN JESSUP: I’ve said it – we may not be able to understand what living with debilitating chronic pain is, but everyone has shown up to work with a bad cold or the flu, and you spend more time thinking about how you feel like garbage than doing your work. And that’s really what’s happening.
GREG DELL: So the way to get around that is to not even necessarily focus on the job title. So when we present a claim for your occupation, we move away from the job title and focus really on the duties. Because it’s unable to do a substantial maturities of your occupation, but it’s the duties part of that that’s really important.
Every single person’s duties is very unique. And when you’re out of the job, you sometimes forget about all the things that you did. And that’s why we spend – we don’t take the one or two lines in the application that say what was your occupation. We do a very detailed description and explanation, which takes a lot of time, to prepare what your occupation was, in anticipation that they’re going to just classify you as a sedentary, light duty, or medium.
And that really goes a long way, because we kind of pigeonhole them away from just saying it’s sedentary, kind of beat them to the punch. And then if they do deny the claim, which doesn’t happen a lot on the applications that we do, we’re ready to say, look, you totally ignored the occupation. You came up with some – or you came up with something that’s not what the person did and that was wrong.
So we’re really laying a very strong foundation for the person moving forward, which is super, super important. It also prepares you for restrictions and limitations if you have a change of definition that’s going to go from your occupation to any occupation, which can happen at the two year mark.
So if you’re considering filing for disability, or you’ve already filed, feel free to give any of our lawyers a free consultation. We’re available to help you anywhere in the country. And we look forward to the opportunity to speak with you.