Long Term Disability Insurance claims are usually governed under federal ERISA regulations. If a claimant goes through the administrative appeals process and is denied their disability benefits, their only remedy is to file a civil lawsuit to enforce their rights under the policy. However under ERISA law, a claimant is usually not allowed to introduce expert vocational opinion evidence to the Court unless it was submitted during the prior administrative appeal. Therefore, it is vital to consider whether a Vocational Report is needed early on in the administrative appeals process.
Obtaining Vocational Expert Opinions
Vocational experts are sometimes called “jobs experts” or “VEs” for short. VEs usually have a Masters or a Ph.D in a field such as Vocational Rehabilitation or Vocational Counseling. Using a claimant’s residual functional capacity (RFC), taking into consideration all of a claimant’s restrictions and limitations caused by their medical impairments, and the claimant’s age, education, background, work experience and skills, the VE can form an expert opinion on what jobs a claimant may be able to perform. The VE could also come to the conclusion that there are no jobs available in the national or regional economy that the claimant can perform. Many insurance policy’s definition of disabled include that the claimant is disabled if he or she cannot find work that pays a certain percentage of their pre-disability income, usually around 80%. A VE will research the local job market and wages and will be able to form an opinion on whether or not there are jobs that the claimant can perform and still meet the salary percentage. An example would be a claimant who performed heavy manual labor, like construction, and now can only do sedentary work. If the claimant does not have the background to do skilled sedentary work, an unskilled sedentary job may not pay enough to reach the salary requirement. That claimant would meet the policy definition of disabled because the VE has found that there are no jobs that the claimant could perform that would pay 80% of his or her salary.
Most major insurance carriers such as Unum, MetLife, Cigna and Aetna have this type of disability definition in their insurance policy. However, proving it will be difficult if a claimant fails to get proper vocational evidence into the administrative record.
If you have questions, ask disability attorney, Marc Whitehead by visiting www.DisabilityDenials.com or you can download Marc Whitehead’s free E-book, Disability Insurance Policies-How to Unravel the Mystery and Prove Your Claim.