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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Lincoln Financial
Uses every dirty trick in the book
It’s next to impossible to get $ out of them without a lawyer. They use plenty of intimidation and unfair tactics. They don’t want to pay. And yet, their CEO made 13 m... read more >
Unum
Unum is evil
On 11/3/2021 I got shot by my boyfriend and my spinalcord got hit, paralyzing me from the neck down and accepting Unum benefits was the worst decision I ever made. I sued ... read more >
Lincoln Financial
Every month I get paid on a different date
I will start by saying that my experience is not as horrible as others, like the folks who have valid claims but get nothing from Lincoln. I feel for you and hope to god y... read more >
MetLife
They will do anything to not approve your claim
MetLife’s handling of my short-term disability claim has been incredibly frustrating and stressful. I followed all the necessary steps prior to my surgery, providing the... read more >
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Sedgwick
Don't trust them, they like to play games
They suck the life out of people that need help. They falsely advertise for helping people that they care. Sorry to tell you it's all about money, they do not care for any... read more >
New York Life
Lyme Disease Disability Claim Denial
I have had repeat claims for genuine medical leave and they have repeatedly been denied by NY Life. I have even been diagnosed with Lyme and going through treatments and t... read more >
New York Life
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I am beyond disappointed with NY Life Disability Insurance’s handling of my father’s claim. My father, a 66-year-old man who has suffered two strokes and continues to ... read more >
New York Life
New York Life is a joke!
This company sucks when it comes to disability claims. They are slow at processing stuff, then they always say they didn't recieve the doctors information. You spend your ... read more >
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Who are Dell Disability Lawyers?
We are disability insurance attorneys that know how to get your short or long term disability benefits paid. As a nationwide law firm we have helped thousands of disability insurance claimants throughout the United States to collect hundreds of millions of dollars of disability insurance benefits from every major disability insurance company.
Our attorneys have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement in more than 98% of our cases. Our disability insurance lawyers have seen it all when it comes to disability insurance claims and we know exactly what it takes for your disability claim to be approved.
We offer disability insurance attorney representation nationwide and we welcome you to contact any of our LTD lawyers for a free immediate review of your disability claim. We also invite you to visit and subscribe to our YouTube channel where we have more than 900 videos and regularly provide tips to help protect your disability benefits.
Who do you help?
Our disability insurance attorneys help individuals that have either purchased a long term disability insurance policy from an insurance company or obtained short or long term disability insurance coverage as a benefit from their employer. We have helped individuals in almost every type of occupation with monthly disability benefit payments ranging from $1,500 to $50,000.
Our clients include all types of employees ranging from retail associates, sales representatives, government employees, police officers, teachers, janitors, nurses, pilots, truck drivers, financial advisors, doctors, dentists, veterinarians, lawyers, consultants, IT professionals, engineers, professional athletes, business owners, and high level executives.
A strong understanding and presentation of the duties of your occupation is essential for securing disability insurance benefits.
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 insurance 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 phone, email, fax, or video conferencing sessions. 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 insurance attorney. We can be reached at 800-698-9159 or by email. Lawyers 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.