What is a "Gainful Occupation" under a Disability Insurance Policy?

The overwhelming majority of employer provided group long term disability insurance policies governed by ERISA contain two definitions of disability depending on what stage your claim is in. As discussed in depth throughout our website the two definitions of disability are what are commonly known as the “Own Occupation” and “Any Occupation” definition of disability. As they imply, the former is an evaluation as to one’s ability to perform their pre-disability occupation and the latter their ability to perform some alternate occupation. Although the period that each definition of disability lasts (12, 24, 36 or 60 months, etc.) and the exact term used (Regular Occupation, Gainful Occupation, etc.) and definition of that term may vary depending on the insurance company they essentially embody the same general idea of “occupation.”

A large number of long term disability claims are denied during the transition between the Own Occupation and Any Occupation stage for the simple reason that the insurance company no longer has to consider how your disabling medical condition prevents you from performing your pre-disability occupation, but rather how your condition prevents you from performing an alternate occupation that is based upon your training, education and experience. These alternate occupations are typically less demanding than one’s original occupation. What can vary dramatically across disability insurance policies is the presence in an earnings requirement/qualified in an “any occupation” definition of disability. Policies that do contain an earnings requirement/qualifier in the definition of “any occupation” contain language along the lines of “an occupation that would pay you 60% of your indexed pre-disability earnings.” However, based on your particular policy language these earning requirements and what they actually mean can vary greatly and improve or hamper your chances of successfully being approved into the “any occupation” period.

So what constitutes the ability to perform an identified occupation under an “any occupation” standard of review?

A recent Federal Court decision from the Northern District of Illinois addressed this issue in the case of Contreras v. United of Omaha Life Insurance Company. In the Contreras case the Court was tasked with determining whether United of Omaha’s denial of benefits to Ms. Contreras was appropriate in light of the Policy’s definition of “gainful occupation.” The Policy defined gainful occupation to mean,

“[A]n occupation, for which You are reasonably fitted by training, education or experience, [and] is or can be expected to provide You with Current Earnings at least equal to 85% of Basic Monthly Earnings within 12 months of Your return to work.”

First and foremost, this is a very specifically worded definition of “gainful occupation” that is not often seen in disability insurance policies. However, the specificity of the language would work to Contreras’s benefit.

During the course of United of Omaha’s review of Contreras’s eligibility for continued disability benefits under the “gainful occupation” definition of disability, United of Omaha conducted a Transferable Skills Analysis (TSA). Based on the results of the TSA, United of Omaha’s vocational consultant determined Contreras would be capable of working as an “Order Clerk.” To refute this assertion Contreras had her own vocational assessment performed that concluded she lacked the requisite training and experience with computer use required of an Order Clerk as set forth by the Dictionary of Occupational Titles. Contreras argued that her limitations related to computer use would preclude employment as an Order Clerk all together or necessitate her having to start in an entry level position that would not meet the required 85% wage requirement in the Policy, and that in light of same she would be disabled under the Policy’s “gainful occupation” definition of disability.

The Court agreed. The Court determined that the administrative record failed to support a finding from United of Omaha’s vocational review that Contreras would be able to meet the wage requirement in the Policy within 12 months of her potential return to work. Instead the Court agreed with the vocational assessment provided by Contreras that established she would not be able to meet the 85% wage requirements within her first year of working as an Order Clerk, and therefore, she was disabled under the “gainful occupation” standard contained in the United of Omaha policy.

Contreras’s case hinged on the “12 month” requirement. The Court noted in its opinion that if the 12 month time requirement had not been in the policy it would have reached the conclusion set forth in established case precedent that absent a time limit in the policy on when the target wage needed to be earned, a TSA identifying a qualifying job would have been sufficient. So if the United of Omaha policy had defined Gainful Occupation to mean, “[A]n occupation, for which You are reasonably fitted by training, education or experience, [and] is or can be expected to provide You with Current Earnings at least equal to 85% of Basic Monthly Earnings,” the Court would have upheld United of Omaha’s denial of benefits.

The Contreras case has very specific facts, but it does shine light on how Courts evaluate “any occupation” standards of disability in light of earnings requirements and how to combat an insurance company’s Transferrable Skills Analysis. In appealing a denial of benefits under an “any occupation” definition of disability it may be advantageous to conduct your own vocational review to establish additional evidence of disability.


Did you find this helpful?
Unhelpful (0)

Resources to Help You Win Disability Benefits

Disability Benefit Denial Options
Submit a Strong Mutual of Omaha Appeal Package

We work with you, your doctors, and other experts to submit a very strong Mutual of Omaha appeal.

Learn more

Sue Mutual of Omaha

We have filed thousands of disability denial lawsuits in federal Courts nationwide against Mutual of Omaha.

Learn more

Protect Your Benefits
Get Your Mutual of Omaha Disability Application Approved
We help claimants throughout the entire application process.

Learn more

Prevent a Mutual of Omaha Disability Benefit Denial
We manage every aspect of your disability claim following claim approval.

Learn more

Negotiate a Mutual of Omaha Lump-Sum Settlement

Our goal is to negotiate the highest possible buyout of your long-term disability policy.

Learn more

Mutual of Omaha Reviews
(642)

Policy Holder Rating

1.7 out of 5
Read 15 reviews
0%would recommend
5
0%
4
0%
3
0%
2
66%
1
33%
Timely Payments
2.4out of 5
Handling Claim
1.9out of 5
Customer Service
1.8out of 5
Dependable
1.8out of 5
Value
2.1out of 5
Showing 8 of 642 Reviews
Mutual of Omaha

I do not understand how a “medical review team” who has never laid eyes on my wife can say she is able to return to work when her doctors who see her on a regular basis have documented that she can't

Reviewed by Dwight on November 14th 2017   Verified Policyholder
My wife fell three years ago and broke her back. She has been found permanently disabled and receives Social Security Disability Benefits. She has also been receiving Bene... read more >
Reply
Sent on November 14th 2017 by Attorney Stephen Jessup

Dwight, please feel free to contact our office to discuss the denial of your wife’s claim. It is unfortunately all too common that an insurance company denies benefit... read more >

Mutual of Omaha

THEY SCAMMED ME AND DID NOT CARE

Reviewed by Debbie on January 31st 2017   Verified Policyholder
We have had life insurance with Mutual of Omaha since 1998 with a chronic illness rider that we decided to use in 2016. Our policy was for 500k, they approved us for 66,95... read more >
Mutual of Omaha

This company is awful

Reviewed by Mike on December 17th 2015   Verified Policyholder
I think there should be laws put in to place to cover the average Joe. This company is awful. They say so much they don’t even know what lies they have told. My husband ... read more >
Mutual of Omaha

I would encourage anyone who has problems with Mutual of Omaha or United of Omaha to immediately contact an attorney.

Reviewed by Robbie Winder on July 24th 2015   Verified Policyholder
I would encourage anyone who has problems with Mutual of Omaha or United of Omaha to immediately contact an attorney. I want to talk about a specific situation in which I ... read more >
Mutual of Omaha

MOO attempted to strong arms me with collection tactics. Now, they're stalling

Reviewed by Jeff on February 11th 2015   Verified Policyholder
I was disabled in 2009 with a multitude of medical problems. I started a process with Mutual Of Omaha Disability. After months of jumping through hoops they finally decide... read more >
Mutual of Omaha

MOO stopped my husband's benefits before telling him. They handled his claim terribly

Reviewed by Jerry on January 30th 2015   Verified Policyholder
My husband has been on claim for disability insurance since July, 2008. He was found to be able to do sedentary work but had no transferrable skills in 8/2009 and benefits... read more >
Reply
Sent on January 30th 2015 by Attorney Gregory Dell

Jerry, you and your husband are certainly not alone in your dealings with Mutual of Omaha. Please feel free to contact our office to discuss how we may be able to assi... read more >

Mutual of Omaha

This company is very corrupt, Be aware

Reviewed by M. Girmes on January 28th 2014   Verified Policyholder
Please hesitate & educate yourself when deciding on short term or long term disability insurance via Mutual Of Omaha. The company is very corrupt. They speak to you like y... read more >
Mutual of Omaha

Mutual of Omaha is a rip off.

Reviewed by Genita Hill on November 13th 2013   Verified Policyholder
Mutual of Omaha is a rip off. When my husband died in 2011, they refused to pay his death benefit because they said he was disabled when I insured him. He retired from his... read more >
Answered Questions by Our Lawyers
(18)
Showing 8 of 18 Answered Questions

Q: Can I ask for another appeal?

Answered on July 13th 2020 by Attorney Alex Palamara
A: Giovanna, you should consult with the attorney(s) that represented you in your appeal to the Third District Co... Read More >

Q: I'm in jeopardy of losing everything because of MOO. Can you help?

Answered on March 3rd 2020 by Attorney Alex Palamara
A: Amy, first and foremost, I am sorry to hear of MOO’s delay tactics and the fact that they sound like they mi... Read More >

Q: Can MOO deny my claim on the basis of preexisting condition when my condition is not preexisting?

Answered on October 27th 2018 by Attorney Gregory Dell
A: Doomed, if your claim has been denied then Mutual of Omaha will give you the right to appeal. Pre-existing con... Read More >

Q: What is my "regular occupation" if I started my own business after resigning from my old job?

Answered on September 1st 2018 by Attorney Gregory Dell
A: Rachel, the answer depends on when you became disabled. If you became injured after resigning from your accoun... Read More >

Q: Am I able to work part time at a different job that is nothing like the one I was at when I was injured?

Answered on June 5th 2018 by Attorney Gregory Dell
A: Russell, whether you can work part time in a different occupation depends on the specific language of the Grou... Read More >

Q: Can I get a lump sum check from MOO?

Answered on May 10th 2017 by Attorney Stephen Jessup
A: Pam, Mutual of Omaha may be willing to negotiate a lump sum buyout of the remaining time on your policy, but t... Read More >

Q: Should I be able to restrict the release of medical records to under 24 months period?

Answered on March 20th 2017 by Attorney Jay Symonds
A: Connie, although you could attempt to limit the medical records to be released to Mutual of Omaha, the likely ... Read More >

Q: Should I write an appeal letter? What should it include?

Answered on March 3rd 2017 by Attorney Jay Symonds
A: Cam, if you are still within your 180 timeline to file an appeal it is imperative that you go through the appe... Read More >
Helpful Videos
(889)
Showing 12 of 889 Videos
Disability Benefit Tips
(331)
Showing 8 of 331 Benefit Tips

What is a "Gainful Occupation" under a Disability Insurance Policy?

The overwhelming majority of employer provided group long term disability insurance policies governed by ERISA contain two definitions of disa... Read More >

Can my insurance carrier deny my benefits even if there is no change in my medical condition?

Insurance companies frequently terminate long term disability benefits after paying a claim for several years, even when the claimant's condit... Read More >

Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?

When it comes to securing your long term disability benefits, it's vitally important that you... Read More >

Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak

If you're seeking long term disability benefits from an insurance company, you may be concern... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability benefits under a long term disability policy, your medical rec... Read More >

Disability Benefit Denial Reason #3 - Video & Social Media Surveillance

One thing many long term disability claimants don't know about (or expect) from the claims re... Read More >

How Do You Fight a Long-Term Disability Denial?

Getting a denial letter from your disability insurance company is one of the ultimate insults... Read More >

Disability Denial Reason #2 - Change of Disability Definition & Vocational Review

One of the top reasons for terminating a claimant's long term disability benefits involves th... Read More >
Dell Disability Cases
(375)
Showing 8 of 375 Dell Disability Cases

After appeal filed by Attorney Jay Symonds, Mutual of Omaha overturned previous denial of short term disability benefits for Maine Senior Software Engineer

Our client, Mr. C, formerly worked as a Senior Software Engineer for a large computer technology company. In April 2016 a number of medical is... Read More >

United of Omaha overturns decision to deny benefits to disabled Quality Assurance Manager after Appeal discredits its medical review and vocational assessment

In 2016, Cathy, a Quality Assurance Manager for a medical device company, sought surgery for a tear in her right rotator cuff. Cathy fully exp... Read More >

After appeal filed by Attorney Jay Symonds, Mutual of Omaha overturned its previous denial of short term disability benefits for Colorado Senior Manager

Our client, Ms. J, formerly worked as a Senior Manager of a treatment facility. In October 2016 a number of medical issues, including fibromya... Read More >

Mutual of Omaha Reinstates Benefits of Business Development Manager after Appealing the Termination of Her LTD Benefits

Our Client, a successful Business Development Manager began experiencing severe physical limitations resulting from fibromyalgia, low back pai... Read More >

Dell Disability Lawyers Successfully Appeals Denial of Benefits to Quality Control Inspector

Pre-disabilityBefore going on disability, Mr. M was working as a quality control inspector for Tam International. In 2009, after years of ... Read More >

Mutual of Omaha Approves Dell Disability Lawyers Client for Short Term Disability Benefits After Administrative Appeal

Our client previously worked as a Senior Accountant/Office Manager for Maccaferri, Inc. Due to her employment at Maccaferri, she was covered u... Read More >

Mutual Of Omaha Overturns Denial of Short Term Disability Benefits for Software Developer With Chronic Back Pain

Regardless of how hard a person attempts to continue working with a disability, it is an effort that gets taken advantage of by the disability... Read More >
Disability Lawsuit Stories
(765)
Showing 8 of 765 Lawsuit Stories

Mutual of Omaha Disability Denial Upheld by Appellate Court

In Giovanna Reichard v. United of Omaha Life Insurance Company (Mutual of Omaha or Omaha), Plaintiff, a nurse employed by ... Read More >

Court Rules Against United of Omaha's Determination of Disability Date

The case of Greggory B. Owens v. United of Omaha Life Insurance Company demonstrates what a difference a day makes. All parties agreed that cl... Read More >

United of Omaha criticized for relying on in-house medical review and failing to obtain independent examinations

This case was decided by a district court in Illinois and involved United of Omaha Life Insurance Company. An ERISA action was filed by the Pl... Read More >

California Court Rules Disability Claim Accrues When Disability Terminates

In Gray v. United of Omaha Life Insurance Co. (United), after working for a southern California television station for 15 years and rising to ... Read More >

Court overturns United of Omaha's termination of Plaintiff's benefits after performing an unfair "any occupation" review

In the case of Mokbel-Alijahmi v. United of Omaha Life Ins. Co., the 6th Circuit Court of Appeals affirmed the lower court's determination tha... Read More >

Registered Nurse Disabled By Plantar Fascitis Wins Long-term Disability Lawsuit Against United of Omaha After Judge Finds Evidence of "Cherry Picking"

From 2002 until 2010, Julia Sun worked as a Registered Nurse caring for quadriplegic patients. Her occupation could not be considered, as far ... Read More >

Court Orders United of Omaha to Pay Death Benefit, Attorney's Fees and Prejudgment Interest

In Brown v. United of Omaha Life Insurance, United unsuccessfully tried to avoid paying a death benefit to Lloyd Brown III, the beneficiary of... Read More >

Washington Court Finds Omaha Wrongfully Relied on Video Surveillance to Deny Disability Benefits

The court discounted the video surveillance, finding "The video surveillance footage was of marginal, if any, relevance." The court continued,... Read More >

Reviews from Our Clients

Request a Free Consultation

Our Lawyers Respond Same Day

5 Ways We Help Get Your Benefits Paid

Get Your Disability Application Approved

Our goal is to get your application for disability income benefits approved. Applying for disability benefits can be a difficult process and the information you provide is critical. Most disability insurance companies look at your application in hopes of finding a reason to deny your claim. Your disability company will ask you to complete numerous forms, interview you, request lots of information, speak with your doctors and possibly request to have you examined by their "hired gun" doctor.

Through our experience of having helped thousands of disability insurance claimants, our lawyers will guide you through the entire application process and give you the best chance to get your disability claim approved the first time.

Submit A Strong Appeal Package

If your disability insurance benefits have been wrongfully denied, then our lawyers know exactly what it takes to get your disability claim approved. You only get once chance to submit an Appeal, therefore every piece of evidence that will support your disability claim must be included. The goal is to win your disability benefits at the Appeal level, but while preparing your Appeal you must consider how a federal judge will review your disability claim if your benefit denial is upheld.

Preparing a strong disability appeal package is an art that requires you to understand how the courts interpret your disability policy language, ERISA regulations / laws, and how to strategically present evidence in support of your definition of "disability". We encourage you to contact any of our lawyers for a free immediate review of your disability denial.

Sue Your Disability Company

98% of the disability insurance lawsuits filed by our law firm have resulted in either the payment of benefits or a lump-sum settlement agreement. Our disability lawyers have filed ERISA governed and private policy long term disability insurance lawsuits against every major disability insurance company in state and federal courts nationwide and we love fighting for the "little guy" against the multi-billion dollar insurance company giants.

We have recovered hundreds of millions of dollars for our clients and we would like the opportunity to provide you with a free review of your disability benefit denial. There are many complex factors in a disability benefit lawsuit and the legal battle to win long term disability benefits can be fierce.

Prevent A Disability Benefit Denial

Approval of long-term disability is a continuous process as every disability insurance company will evaluate your eligibility for benefits on a monthly basis. You can never let your guard down and assume that your disability company will continue to pay your benefits for as long as you think you need them.

Our law firm offers a reasonable flat fee monthly claim handling service in which we handle every aspect of your long-term disability claim and do whatever it takes to make sure you are paid every month.

Negotiate a Lump-Sum Settlement

Let's discuss if a lump-sum settlement or buyout of your disability insurance claim is both available and makes financial sense for you. Our lawyers have negotiated more than five-hundred million dollars in disability insurance buyouts and we know how to get you a maximum settlement. A disability insurance company is not required to offer a buyout and not every disability company offers them.

Questions About Hiring Us

Who are Dell Disability Lawyers?

We are disability insurance lawyers 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.

In more than 98% of our cases, our lawyers have been able to either get our clients paid monthly disability benefits or obtain a one-time lump-sum settlement. Our 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 welcome you to contact any of our attorneys 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 700 videos and regularly provide tips to help protect your disability benefits.

Who do you help?

Our lawyers 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 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, GoToMeeting 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 800-698-9159 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.