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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FAQ

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   *****

Marlene D.

When I saw myself in the need to seek legal advise, I didn’t quite know where to turn, since I hadn’t needed one ever before. So… keeping up with the times, I turned to the internet. I was a little leary about that, considering that one can’t believe everything one sees on the net; I however am very happy that I did. I guess it was my lucky day cause I found the law firm of DELL & SCHAEFER.

I contacted them and was assigned to attorney Rachel Alters. From the beginning she was easy to speak with, down to earth and very clear in her responses when questions were asked. I felt that she was honest and had my best interest at heart from the get go. She was very clear in saying that she could not make any promises, but she would do everything possible to help me, and she surely did. I can’t not mention her assistant Kathleen Borges, who was also awesome and very prompt returning my e-mails and phone calls. THANK YOU both for solving my case and giving me back some peace of mind.

In a nutshell, after working as a RN for 37 years, I became disabled due to complications from Rheumatoid/Osteo Arthritis and ended up with bilateral Knee Replacements. As most RN’s do, I purchased long term disability through my job’s group plan and can’t remember a time when I didn’t. The insurance company paid me for 2 years and then decided that I could go back to work in sedentary positions, which they even chose for me and could not have been further from my reality. At this point is when I decided to seek legal advise.

I’m sure there are many others in my similar situation so I want you to know there is help out there… there is Rachel Alters / Kathleen Bordes… there is……….. DELL & SCHAEFER!

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