How does a disability insurance company determine my Regular Occupation?

The overwhelming majority of employer provided ERISA group disability policies provide disability benefits for a certain period of time if you are unable to perform the material and substantial (or similar language) duties of your “own” or “regular” occupation. Although the semantics may differ from policy to policy, under the own/regular occupation period is intended to provide benefits if you cannot do the job you were performing prior to going on disability. The “own/regular occupation” period usually lasts anywhere from 12 to 24 months, and sometimes as long as 60 months or until age 67. One thing that many people become aware of after they have already filed for disability is the fact that the disability insurance carrier does not necessarily review their occupation as it is performed for a specific employer, but rather how it is performed in the national economy.

How an Insurance Company determines your Own/Regular Occupation

When a claim for disability insurance benefits is filed, the insurance company normally, but not always, obtains a copy of your job description from your employer; or in the alternative will send a claim form to be completed by you, the claimant, or by your employer as to the duties of your occupation. However, as noted above, this does not mean that the insurance company will take this information on face value. Often a vocational review is conducted to determine what occupation your actual job most resembles according to the Department of Labor (normally by way of the Dictionary of Occupational Titles (DOT) or O*Net) or some similar occupational resource. This is why if your claim has ever been denied and you say to yourself, “They got my job wrong. That isn’t what my job required.” Insurance companies usually have vocational consultants on staff and they will conduct their own vocational analysis.

The Dictionary of Occupational Titles (DOT) and O*Net

Chances are if your claim has been denied during the own/regular occupation period the denial letter contains some wording along the lines of, “Pursuant to the DOT, your occupation is classified as ____ physical demand level.” So what is the DOT? The DOT was a codification of occupations as set forth by the Department of Labor. Review of the DOT website indicates that the information contained in the DOT is dated, especially since the Department of Labor has no updated the definitions since the mid 90’s.

If you click to the O*Net link contained on the DOT website, it states that O*Net has replaced the DOT. Review of the job descriptions as identified on O*Net are much more in depth and provide a better comparison as to the actual demands of one’s occupation. However, more often than not insurance carriers rely solely on the DOT job description and not the O*Net. This is why when filing administrative appeals for clients under an ERISA Group Disability policies we always research the job descriptions for both the DOT and O*Net among other sources we rely upon. We routinely retain vocational consultants to conduct employability analysis and labor market analysis.

Click here to read about a disability lawsuit against Mutual of Omaha where the court required the disability carrier to rely upon ONET data rather than DOT standards for determining occupation.

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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.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

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