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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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.

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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, 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.

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I was getting nowhere with my absence management company. They cut off my only source of income two weeks before I was to go on long term disability. They kept giving me excuses as to why they would not finish out my STD payments.

That is when I enlisted the services of Attorneys Dell & Schaefer and am I ever glad I did. They got the ball moving immediately and worked diligently to substantiate my claim. To my surprise, I was told that they were able to secure both my remaining STD payments as well as retroactive LTD payments. I would not recommend anyone going through similar circumstances to attempt to do things on your own. Go with the expert professionals, Dell & Schaefer.

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