Long-Term Disability Benefits Claim Tips for Managers
By Gregory Dell and Rachel Alters
Long-term disability benefits claim for managers can be a minefield if you aren’t prepared. The term “manager” covers an incredibly large and diverse occupation category: healthcare managers, hotel managers, bank manager, retail store managers, and restaurant managers, as an example, all have very different responsibilities and occupational duties.
Unfortunately, disability insurance carriers tend to lump them together by using the term “manager” as defined in the National Economy Standard failing to look into the specifics of your actual job. This can negatively affect your disability claim: often, managers have to perform a variety of duties including lifting items, traveling, attending meetings, supervising numerous employees, helping employees, or being on their feet all day, whereas the insurance carrier simply sticks to the Department of Occupational Titles definition that does not encompass the full job description.
This can be frustrating, and often, it’s up to disability insurance attorneys to make the insurance carrier understand that the job of a manager is not just how the National Economy defines it.
This is why it’s crucial to present the duties of your occupation in a clear, concise, and detailed manner.
The insurance carrier may try to portray the job duties of managers in a simplified way when in actuality, as a manager at, say, Costco, you might be managing 300 employees, answering phone calls, lifting boxes, and being on your feet all day. There may be a lot of physical responsibilities that a manager has to undertake on a daily basis; however, disability insurance carriers like Prudential, Unum, or Cigna might claim they’re simply going with the National Economy Standard definition of “manager” which typically does not include the multitude of physical and mental tasks and responsibilities that you might have as a manager. The insurance carrier might claim that, going by the National Economy Standard definition, your job as a manager is mainly sedentary, and therefore deny your disability claim.
Naturally, most managers do not have purely sedentary jobs: they need to supervise teams of people, solve problems, and constantly be on their A-game. In some ways, managers are a little like firefighters – their job is to put fires out on a daily basis, and they do not have the luxury of taking long breaks to take their medication or lay down if they’re feeling unwell.
Unfortunately, disability carriers don’t look at it like that: instead, they might say, “well, you can lift 20 pounds, or you can sit in a chair for more than four hours, so we don’t see why you can’t do your job”. This is why it’s so important to present all your duties in a detailed way so the claims examiner and the disability insurance company will take them into account.
Detailed Documentation of Medical Records
In addition to presenting your occupational duties, it’s equally critical to have a well-documented medical history detailing all the medical issues and support you have been receiving over time.
Your treating physician needs to carefully document all your restrictions and limitations caused by your medical condition. This documentation needs to be ongoing – it cannot just be last week’s doctor’s visit where the treating doctor says you cannot work anymore. Instead, it needs to show a continuum of care over a period of time – a few months, six months, or however long your condition has progressed and worsened to a point where you cannot perform your occupational duties as a manager.
Disability insurance companies don’t just look at a form filled out by your treating physician or a letter stating “I believe that my patient is disabled due to their back condition and they can no longer be a manager”. What the insurance carrier really is looking at is the continuity of care, the medical records, the tests, and all the progress notes. They mainly want to see objective proof such as MRIs, X-rays, or any kind of testing you’ve undergone that can clearly show your condition is severe enough to prevent you from working.
In addition, the medical records need to be as descriptive as possible. You have to tell your doctor all the specifics – that you are in pain; how bad is the pain; whether you’re losing sleep or having difficulties standing or sitting for long periods of time – all of this needs to be carefully documented because it’s an extremely important part of your claim.
As a manager looking to submit disability insurance benefits claim, you might want to consider involving a disability lawyer at this point. An experienced disability insurance attorney can review your medical records through the eyes of your insurance carrier and work directly with your treating doctor to help them document your condition better, be more descriptive, and use the right terminology.
Doctors typically aren’t trained to get disability claims approved – they are trained to treat patients. It’s not their priority to write records for insurance carriers that will approve benefits, so as a claimant, you need to ask your doctor to please document more specifically, be more descriptive, and use certain terminology in the medical records. A disability insurance lawyer can help mediate this process and if the medical records aren’t detailed and explanatory enough, they can reach out to your doctor and make sure the records are more supportive before submitting the claim.
ERISA-Governed Insurance Policies
In our experience, the majority of the managers we represent are typically employed by a company, which is usually a larger or mid-sized entity, rather than owning their own enterprise. As a result, managers receive their long-term disability insurance as an employee benefit, and because of this, their claims will be governed by ERISA (Employee Retirement Income Security Act).
This is significant as ERISA-governed policies fall under a different administrative process than personal insurance policies (for example, there is no jury trial in case a claim has been denied and the claimant appeals). Under ERISA guidelines, there are more rules and regulations that are stricter than under personal insurance policies purchased on your own.
This is why it’s extremely important to get things right from the start during the claims process: once the application is submitted, the insurance carrier will treat things as if they’re written in stone and it’s very hard to back-pedal.
When it comes to the appeal, if the claim is denied, the majority of insurance companies do not permit a second appeal (there are perhaps one or two exceptions), which means you have only one opportunity. This appeal is essentially your trial, so you must include everything you want the judge to see if your appeal is denied.
Once the appeal is reviewed by the insurance carrier and if they don’t overturn their decision and don’t approve your claim, nothing else can be added. Once that claim is closed, if something happened the day after – for example, you got approved for Social Security or, God forbid, you got in a car accident or were more severely hurt – none of it comes in. All the judge is going to see is whatever is in that appeal.
This is why it’s vital to make sure it’s complete, all the medical records are submitted, all the testing has been done and everything is prepared in a nice big package for the insurance carrier to hopefully overturn the benefits. If they do not, the administrative judge will get all of that as well.
When to Get a Disability Insurance Attorney Involved
A disability insurance benefits claims process for managers can be daunting; to ensure success, it’s important to educate yourself as best as you can. Feel free to browse our website for more information and resources on handling disability insurance claims and appeals by your condition, your insurance carrier, or your occupation.
We especially recommend looking up your insurance carrier: every company, whether it’s MetLife, Unum, Hartford, Cigna, or the like, has its own nuances, and it’s best to research and browse cases specific to your insurance company.
Finally, it’s worth considering hiring a disability attorney to help you navigate the disability insurance benefits claims and appeals processes for better chances of approval.
Don’t hesitate to call Dell Disability Lawyers (nationwide) for a free consultation where an experienced attorney will review your claim and let you know exactly how we could help.
