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Federal Court Examines Vocational Reviews and ERISA Disability

What is an Occupation?

Pursuant to the vast majority of ERISA governed disability insurance policies, an Occupation is defined based on one of two standards – Own Occupation or Any Occupation. Quite often an insurance carrier will overlook the actual duties of an occupation and simply determine the ability to work based on the physical demand level associated with a particular occupation. If you are receiving disability insurance benefits or have been denied benefits you have most likely read somewhere in correspondence from the insurance carrier that they have deemed your occupation to be “sedentary” or “light duty.”

In the event of a claim denial an insurance carrier will typically indicate it has determined you can perform sedentary duty work (or any other corresponding physical demand level) and can therefore work in your “own” or “any” occupation. However, it should go without saying that the ability to perform at a particular physical demand level is by no means indicative of the ability to actually perform the material and substantial duties of an occupation. Unfortunately, insurance companies often fail to understand this logic.

Vocational Analysis

An insurance company typically conducts a vocational analysis/review to determine what constitutes the material duties of a particular occupation, and in doing so typically rely on a variety of vocational resources such as the Dictionary of Occupational Titles, O*Net, Job Descriptions, etc. to complete the review. Failure to conduct such a vocational review as part of the claims determination process has been deemed by multiple Federal courts to be evidence arbitrary and capricious claims handling.

In a recent ruling from the United States District Court for the Northern District of Illinois, Eastern Division in the case of Daniel Travis v. Midwest Operating Engineers Pension Plan, the Court echoed this established opinion. In the Travis case, the Court reviewed Mr. Travis’s entitlement to Total Disability Pension benefits under an ERISA governed pension plan. In denying Mr. Travis’s claim for total disability benefits the Pension Plan relied upon its medical reviewer’s opinion that Mr. Travis could perform a sedentary demand level job and that based on that assertion alone the Pension Plan was not required to perform a vocational review.

The Pension Plan argued to the Court that the Plan did not expressly state that vocational considerations had to be taken into account when determining whether Mr. Travis was totally disabled. Mr. Travis’s attorney argued that the Pension Plan could not construe the terms of the plan so strictly as to mean that if Mr. Travis could engage in any physical activity whatsoever that he could work regardless of any required vocational qualifications. The Court agreed with Mr. Travis, holding the Pension Plan abused its discretion by failing to perform a vocational analysis to determine whether Travis could work in some vocation given his physical restrictions and limitations. The Court remanded the case back to the Pension Plan to conduct a vocational analysis to determine Travis’s entitlement to benefits.

What to do if your insurance company is evaluating your claim for disability benefits using improper vocational information

If your insurance company is not properly determining vocational ability in light of the applicable definition of disability do not wait till a denial of benefits before challenging the carrier’s assertion. Please feel free to contact our office to discuss how we may be able to assist you ensuring that your insurance carrier is properly reviewing your claim.

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I had to retire from my career due to a bad back that restricted me from performing my duties. I had LTD insurance and after a few years of receiving monthly benefits from this insurance company, they notified me that my benefits were terminated stating that I don’t qualify due to my duties not fitting into some “national job description” and a nurse had deemed me eligible to go back to work. It’s a crushing feeling to have this told to you over the phone with hardly any information given. Luckily, I came across Dell Disability Lawyers and spoke with Attorney Palamara who calmed me down and stated they would take my case. Within a couple of months my benefits were restored, and I had piece of mind. I cannot thank Attorney Palamara and the staff at Dell Disability Lawyers enough for their professionalism, no nonsense approach, personal and timely communication and quick ability to litigate my case.

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I wanted to thank Mr. Symonds and his legal assistant Sonia for their professionalism, guidance and dedication towards my LTD insurance claim. Going through the denial process on my own was going to get me sicker and I knew it was time for help right away. I reached out to Dell Disability Lawyers for assistance and not too long after my call, I was connected with Sonia. Soon after that, I was talking about my case with Mr. Symonds. After a long and tedious process with the LTD insurer, we won the case. The wait can absolutely be lengthy, but in the end, it was all very much worth the fight. Thank you both so much for all that you have done for me! I also want to thank those who assisted in keeping me updated, as needed. Highly recommended for anyone who is going through the brutal process of an LTD denial.

Carl G.

I would like to thank Dell Disability Lawyers for taking care of my case and help me get the insurance coverage that I was rightfully in need of. Specially, I would like to thank Attorney Alexander Palamara and right-hand legal assistant, Sonia Nogueira, who made this process less stressful. They answered all my questions and kept me informed every step of the way.

Don’t get me wrong. They never promised or told me that I was going to win my case, as no one can guarantee that for you. What they did do, was letting me know that they were working hard for me and to keep positive. Something that I recommend everyone to do is to subscribe to their YouTube channel. That will give you an idea on how they operate and why they (for most of their cases) win their cases.

Since I was awarded disability, I am still having surgeries and thanks to them, I’ve been able to cover all those expenses.

Warm regards to everyone at Dell Disability Lawyers!

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