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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.<\/p>\n
GREG DELL: Hi, I\u2019m 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.<\/p>\n
I don\u2019t know if it\u2019s a misconception or whatever, but people call you and they say about this policy to protect my occupation and I can\u2019t do it. And so, therefore, the disability carrier should pay. So let\u2019s focus this on when we\u2019re 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.<\/p>\n
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\u2019re trying to get at different information. That\u2019s going to be based a lot in the language in the policy, especially when it relates to own occupation, any occupation.<\/p>\n
But one of the things you really have to look for in a policy is, in defining \u2013 a lot of times your own occupation, regular occupation, will be a defined term in the policy \u2013 and a lot of times it says how that\u2019s performed in the national economy and not for your specific employer at the specific location you do the job.<\/p>\n
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.<\/p>\n
GREG DELL: So if we take a person who might be a computer engineer, or a computer consultant, someone who\u2019s doing IT, a very common type of claimant that we would assist with a claim. And they say, OK, I\u2019m an IT person working for this company, and I\u2019m unable to do my job.<\/p>\n
Well, the first thing is that the disability insurance company may look at that as IT consultant and they assume that you\u2019re working at a desk. And so talk about how they have these classifications of jobs and why that\u2019s important in how an insurance company looks at it versus how we like to present a claim.<\/p>\n
STEPHEN JESSUP: So the Department of Labor has standards. There\u2019s 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\u2019ve seen it where they list what your job is.<\/p>\n
Here, it\u2019s an IT consultant. And they may say according \u2013 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\u2019re going to deny your claim. So it really goes into, and you can sometimes see it in an employer\u2019s job description, the physical-ness of it, where it may go.<\/p>\n
Obviously, in IT \u2013 when we see our IT guys around here, they\u2019re moving computer equipment, monitors. So there is a level physical-ness. It\u2019s also been out in the field, if you will. IT doesn\u2019t work in a bubble, where they\u2019re sitting at a desk all day at their home facility.<\/p>\n
A lot of times they\u2019re out, so there\u2019s 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.<\/p>\n
So we really list out what it entails. It can come from the employer\u2019s job description. But also, I think it\u2019s always important\u2013 on the claim forms, they don\u2019t 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.<\/p>\n
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\u2019s 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 \u2013 what is it \u2013 like, two five minute breaks during the day or something like that.<\/p>\n
And then they\u2019ll say to the doctor \u2013 they\u2019ll send that Dictionary of Occupational Titles description to a doctor, not anything that has to do with what the person\u2019s job is. Sometimes, they don\u2019t even tell them what the person does. They just say, it\u2019s a sedentary job, do they have any restrictions, limitations stopping them from doing a sedentary job?<\/p>\n
And so, then they\u2019ll come back and say \u2013 nope, no restrictions with sitting, no restrictions with bending, no restrictions lifting. And the carrier says, OK, you\u2019re not disabled, because you can do a sedentary job.<\/p>\n
STEPHEN JESSUP: And also, with that too, that\u2019s assuming that the reason why you can\u2019t 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\u2019re going to look at just the physical.<\/p>\n
But when you\u2019re in pain or you\u2019re on medication, are your faculties for doing your job there? And this idea with sedentary \u2013 because as lawyers, our job\u2019s sedentary.<\/p>\n
And anyone who has a sedentary job, in a lot of ways \u2013 I joke sometimes. I\u2019m 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\u2019s not what work is. So you\u2019re right, they just go to these classifications without really getting into what you do for a living.<\/p>\n
GREG DELL: Right, and they don\u2019t \u2013 and then it\u2019s like the people deciding the claims forget about what they do every day. Look at even the person who\u2019s evaluating the claim. In a given day, you come in, and you have 10 things you want to get done that day, because they\u2019re reviewing 100 different claim files. Now they\u2019ve got 30 phone calls they weren\u2019t expecting that day.<\/p>\n
They\u2019ve got to write up responses to four different appeals. They\u2019ve got to evaluate 10 different applications. They\u2019ve got to review hundreds and hundreds of pages of medical records, and reviews, and read all that. Now assume that person \u2013 let\u2019s just go with a neck issue \u2013 has neck pain, where if they\u2019re sitting in a position for more than five minutes, their next starts to hurt.<\/p>\n
Well, I know, I mean everyone\u2019s sprained their neck or sprained their back. Once that starts bothering you, and the people who are filing claims have that pain continuously, it\u2019s really hard to focus on what you\u2019re doing. Let alone now, you\u2019ve got three different meetings you\u2019ve got to do during the day. You\u2019ve got a checklist of appointments setup.<\/p>\n
And what do you do when you\u2019re not feeling well? You\u2019re not focused. I mean, think about common sense, when someone doesn\u2019t feel well just in a social atmosphere, they\u2019re not all there.<\/p>\n
STEPHEN JESSUP: I\u2019ve said it \u2013 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\u2019s really what\u2019s happening.<\/p>\n
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\u2019s unable to do a substantial maturities of your occupation, but it\u2019s the duties part of that that\u2019s really important.<\/p>\n
Every single person\u2019s duties is very unique. And when you\u2019re out of the job, you sometimes forget about all the things that you did. And that\u2019s why we spend \u2013 we don\u2019t 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\u2019re going to just classify you as a sedentary, light duty, or medium.<\/p>\n
And that really goes a long way, because we kind of pigeonhole them away from just saying it\u2019s sedentary, kind of beat them to the punch. And then if they do deny the claim, which doesn\u2019t happen a lot on the applications that we do, we\u2019re ready to say, look, you totally ignored the occupation. You came up with some \u2013 or you came up with something that\u2019s not what the person did and that was wrong.<\/p>\n
So we\u2019re 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\u2019s going to go from your occupation to any occupation, which can happen at the two year mark.<\/p>\n
So if you\u2019re considering filing for disability, or you\u2019ve already filed, feel free to give any of our lawyers a free consultation. We\u2019re available to help you anywhere in the country. And we look forward to the opportunity to speak with you.<\/p>\n