When filing a long term disability claim under an employer-sponsored plan, it is important to describe the job duties that you really do. Not realizing the importance of this, many applicants write in their job title and the brief, standardized job description provided by their HR department.
Often these descriptions are too general or not representative of the work you truly do each and every day.
Those who become disabled and can no longer do their jobs are surprised when the insurance companies deny their claims. Little do they know that how they portray their occupation can play an important role in this outcome.
How Is Your Job Defined in the Insurance Industry?
In the above video, attorney Marc Whitehead explains how insurance companies will determine a claimant’s skill level. Whether you are a dentist, an office clerk, a sheriff or a truck driver, under an ERISA-based disability insurance policy, your occupation generally will fit under one of three levels of skill:
- Unskilled / semi-skilled
- Very skilled
To make an appraisal of your skill level, the insurer may consult a vocational expert to conduct a vocational assessment. The vocational consultant will generally refer to the Dictionary of Occupational Titles (DOT) and other similar resources to support their findings regarding your training, skill levels and experience.
The ultimate goal is to determine whether you are able to return to work.
For an insurer to pay you LTD benefits, your disability must be severe enough, and of sufficient duration, to keep you from going back to work. Since no universal definition of disability exists, your policy will define disability according to the insurance company’s directive.
Most group policies define disability as “Own Occupation” coverage – you are covered if you cannot perform the duties of your own occupation.
But here’s the wrinkle: Usually after 24 months, the policy definition of disability changes. The Own Occupation provision shifts to Any Occupation.
Even if you are unable to return to your own, pre-injury job after that 24 month period, most ERISA policies allow the insurance company to consider your ability to return to any occupation.
This is especially dangerous if your job duties listed in your claim are vague and leave room for misinterpretation, or are inaccurate.
Insurers Want to Prove You Can Do Other Jobs
Vocational consultants can be very effective when the “any occupation” disability standard applies. It is harder to prove that you cannot do the tasks required in any job, than it is to prove you cannot perform the specialty duties of your own, more complex job.
So a deciding factor in most group disability insurance claims is whether you can do other work, often in occupations with a lower skill level. When the definition of disability changes after 24 months, this is often when a claimant’s LTD benefits are terminated.
Best Practices for Describing Your Job Duties in a Group Disability Claim Application
It’s easy to make a lower level job sound like it requires more skill than it actually does. But that is human nature and often how we’re conditioned to respond – and can be the undoing of a long term disability insurance claim.
Remember: you are trying to prove you cannot physically do your job. The more skilled you appear to be, the more ways the insurance company can allege there is other work you can do.
Take every precaution when filling out your actual job duties on the claim application. When you prepare you occupation’s description:
- Overstate or stretch the truth about what you actually do
- Embellish marginal skills or include unrequired skills
- Exaggerate vocational training, experience or education
- List the fundamental tasks and duties of your job that you perform routinely. Explain your job in the most physically demanding way you can.
- Include the mental and cognitive requirements of your job.
- If needed, use extra sheets for complete documentation (the claim form may give you just one line to provide this information.) Present it in a clean, legible format.
- Be careful when answering unclear or misleading questions that could lead to unfair determinations about your occupation.
- Gather any documentation that unquestionably defines your job duties.
Whatever Your Skill Level, Proving You Cannot Work Is Key
You must develop and present compelling evidence you are physically unable to engage in your own job or in other work. Which is why, from the very start, you want to provide the insurance carrier with a true, unembellished account of your actual job duties.
If your claim is denied and your case goes to trial, the insurer will have a much harder time explaining to the court why it disregarded your actual job duties to support their decision to deny.
Many cases are lost not because the claimant is not disabled, but because they made a preventable mistake in their claim—such as using the employer’s general job title and vague description of the job, instead of writing out a complete and factual job description.
Have You Been Denied?
If you become our client, we take on the burden of proving that you are disabled from any occupation.
We work closely with physicians, our own vocational experts of our choosing, employers, coworkers and CPAs to provide the claims examiner the most accurate medical, vocational and financial information to support your claim.