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.

manager occupation disability benefits claim denial

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.

manager disability insurance benefits denial

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.

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Disability Company Reviews
(642)
Showing 8 of 642 Reviews
Sedgwick

AT&T Was Great and Sedgwick Horrible

Reviewed by From a great job to a complete nightmare on March 20th 2024   Verified Policyholder | March 2024 date of disability
My Physician recommended that I take some time from a toxic environment after several deaths in my family coupled with AT&T trying to run tenured employees out of the door... read more >
New York Life

Keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting

Reviewed by M.T. on February 15th 2024   Verified Policyholder | May 2023 date of disability
I have been appealing a claim for LTD for 8 months! New York Life keeps claiming they will not approve claim for pre existing conditions but my illness is not preexisting ... read more >
Reliance Standard

Staff Lie

Reviewed by Tanya on February 12th 2024   Verified Policyholder | August 2021 date of disability
I had my disability cut off the day I was scheduled to find out whether I should have surgery. The claims examiner was aware that I had an appointment on that date and sai... read more >
Reply
Sent on February 12th 2024 by Attorney Gregory Dell

I am sorry to hear about your experience. It’s crazy that Reliance Standard would deny your disability benefits when you are suffering so badly that you need surgery.... read more >

Hartford

Former Hartford employee has had life insurance and accidental death policy's revoked for one late premium payment

Reviewed by Becky H. THOMAS on February 12th 2024   Verified Policyholder | February 2024 date of disability
Dislike how they are constantly interrupting the lives of their disabled EE's whom are entitled to benefit which they paid into out of there pay check every pay period onl... read more >
Reply
Sent on February 12th 2024 by Attorney Gregory Dell

Thank you for your review of Hartford and we appreciate you sharing.  It’s sad they don’t take care of their own employees.

Lincoln Financial

Never received benefits my entire leave - or help with them

Reviewed by Anna on December 19th 2023   Verified Policyholder | November 2023 date of disability
I used my short term disability insurance for maternity leave and started the process beforehand knowing when I would be out (scheduled induction.) It took a little over a... read more >
Sun Life

Unscrupulous Tactics

Reviewed by Misseekayy on December 19th 2023   Verified Policyholder | May 2023 date of disability
Sunlife uses unscrupulous tactics in order to prevent payment of claims. They wait until it is close to the 30 day mark and then they ask for another form of information o... read more >
Sedgwick

Lame

Reviewed by Dennis T. on December 11th 2023   Verified Policyholder | March 2022 date of disability
My experience with Sedgwick and personell is as follows: Unhelpful, unprofessional and an overall unpleasant experience.
Unum

Low payments

Reviewed by Dorothy on November 30th 2023   Verified Policyholder | November 2023 date of disability
I was injured at work. I did house keeping in a hospital. I tore just about everything imaginable in my knee. I was let go from my job, because I was no longer able to do ... read more >
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What is Addison’s Disease?Our client is a 43-year-old male who was employed as a Manage... Read More >

Hartford Reinstates Disability Benefits to HR Manager

I recently wrote an article regarding the relationship between Rheumatoid Arthritis (RA) and Cognitive Dysfunction that discussed increasing m... Read More >

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In 2016, Sarah, an Account Manager, began suffering severe abdominal pain accompanied by bloody diarrhea. The frequency and condition was so s... Read More >

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In Craig Robertson v. Principal Life Insurance Company, Plaintiff, a National Account Sales Manager with XPO Logistics in Phoenix, A... Read More >

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It is important to point out that this case was not handled by Dell & Schaefer. However, we wanted to write about this case as there is mu... Read More >

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