Does ERISA require Plan Administrators to have my claim reviewed by an independent vocational expert?

The answer to this question of course, is, it depends…

Many plans explicitly define disability as an inability to engage in employment for which the applicant is “reasonably qualified by training, education or experience.” This language typically defines the “any occupation” definition of disability. Plans containing this language require Plan administrators to conduct some level of analysis of the claimant’s particular vocational circumstances.

Such language is not universal to all ERISA plans, however. In a recent case out of the Northern District of Illinois, a U.S. District Court held that “ERISA does not impose a blanket requirement on plan administrators to obtain independent vocational expert analysis.”

The claimant, Mr. Edelman, filed suit against Roofers’ Pension Fund seeking disability benefits and arguing that the Fund had erred by failing to conduct a vocational assessment, which according to him, would have confirmed that he lacks the education, skills, or experience necessary to secure sedentary employment.

To support his argument, Mr. Edelman cited several cases in which a denial of benefits was reversed because the plan administrator failed to consider the claimant’s individual vocational characteristics. The court, however, pointed out a material difference between Mr. Edelman’s claim and the cases cited by him – specifically, the court noted that the Plan at issue did not contain certain language which would necessitate an individualized vocational assessment.

The court explained:
“Indeed, many plans explicitly define disability as an inability to engage in employment for which the applicant is ‘reasonably qualified by training, education, or experience’… a plan incorporating this kind of terminology necessarily ‘requires some individuation in the analysis’ of benefits entitlement.”

However, the court went on to explain that where such language is absent courts have upheld a denial of benefits although the plan administrator did not have the claim reviewed by an independent vocational expert.

Since the plan under which Mr. Edelman was seeking benefits did not contain similar language the court concluded that the Plan Administrator was not required to obtain independent vocational expert analysis – or rather, that the Fund’s determination could not be deemed so unreasonable as to compel a reversal of the Fund’s denial.

In sum, whether Plan Administrators are required to have your claim reviewed by an independent vocational expert ultimately depends on the language in your particular insurance policy.

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Questions About Hiring Us

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

How can I contact you?

When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Dell & Schaefer Client Reviews   *****

Ravindra P.

I have been a client of Dell & Schaefer for the 6 months and they have already successfully taken my disability claim to approval. It is privilege to write this testimonial. I am a professional myself, a physician and to me these are some of the core strengths of Steve Jessup and his team.

Listening to the client: Attorneys at Dell & Schaefer really listen to you explain your special situation and undoubtedly every one of us has a special circumstance and specific wishes as to what we want. Most of the time attorneys and in general most professionals these days, will listen to you a couple of minutes and then file you away in a category or a bin and chalk out a plan for you in their mind and stop listening to you and start thinking about the next thing that they have to do. That is why these interactions are so often exasperating for the client.

As a physician I used to try and teach medical students that any well trained monkey can read a few books and do a particular thing in a particular situation, it is however extremely essential that you determine what the situation is and no one understands the situation better than your client or patient. I spoke to a couple of attorneys at D&S, initially with someone who took my call and then Steve who was assigned to me and it was impressive that they really tried to get what I was trying to convey, what my special and unique situation was (and whose isn’t?) and what I wanted.

Shock and Awe: At Dell & Schaefer they don’t go in halfway prepared. Their philosophy is to get well prepared and go in guns blazing. They will make you work on your mission until all anticipated difficulties have a contingency plan before even the adversary is intimated of the challenge. I believe it was Sun Tzu who said that the best battles are won before they are fought. Frequently you are a small David pitted against a Goliath adversary with deep pockets and a much larger time horizon. But you do have an advantage, that of time for preparation. The adversary does not know of the battle until you tell them and then the clock starts ticking. At Dell & Schaefer they make full use of your advantage by preparing your case with utmost thoroughness before the engagement.

Art of the possible: Legal action, just like life, is the art of the possible. I have dealt with 5 other attorneys in my career and only one of them apart from Dell & Schaefer understood this. A professional’s job is to tell you what the score is, what possibly can occur in the future and what measures can be taken to favorably change the future. And the last one is possibly the most vital. You don’t want your attorneys telling you all the time why things cannot be done, how laws are stacked against you, how global warming is melting the icecaps, how the oil is running out and how dogs sometimes eat homework assignments. You want them taxing their brains to see what can be done in best manner possible, so the future, which is not yet written, changes favorably for you. Attorneys at D&S get this and consciously incorporate it in their work ethic.

They say that there are four professionals in your life who should also be your friends. Doctor, Lawyer, Accountant and Banker. There is a deeper side to this sound bite that some people get and some don’t. I live at the other end of the country from where Dell & Schaefer work and play, but the world is small and getting smaller and perhaps someday I can add to my stock of friends.

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