When making a claim for LTD benefits, it is extremely important to read and understand the definitions contained in your policy such as the “own or regular occupation” and “any gainful occupation” definitions. If you are not aware of these definitions in the policy before you submit your claim, your treating doctors may not be providing the proper support from your inability to work. An example of this very situation arose in a Pennsylvania District Court case, Pini v. First Unum et al.
In Pini v. Unum, the existence of a disability was dependent upon the probability Ms. Pini would suffer a relapse of her cardiac condition if she were to work in her occupation as a product analyst, but for a different employer. According to the Plaintiff’s treating doctors, she would likely experience a relapse of her cardiac condition if she were put back into the extremely stressful work conditions she experienced in her specific job with her previous supervisor which may cause her stress induced cardiomyopathy. Unfortunately, Pini’s doctor stated that she could perform the duties of her occupation for a different employer. As a result, the Court determined Unum was correct in denying her benefits.
The Plaintiff’s policy defines “regular occupation” as follows:
Regular Occupation means the occupation you are routinely performing when your disability begins. The Plan Administrator will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.
The court held that Unum did not abuse its discretion denying Pini’s benefits since her own treating physicians stated that she was able to work in her occupation for a different employer, just not her current employer as her supervisor caused her severe stress. Under the terms of the policy, one is disabled if they cannot perform their regular occupation when the disability begins, however, it is how that occupation is performed in the national economy and has nothing to do with the specific work conditions a claimant is exposed to in his or her pre-disability occupation.
It is very important to review your policy and have a conversation with your treating physician prior to filing a claim in order to ensure that they are supporting your inability to work in accordance with the terms and definitions of your LTD policy.
Our disability lawyers are available to answer questions related to a Unum disability insurance claim or denial or any other disability insurance related claim.