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What is an “any occupation” definition of disability?


  • What is the "any occupation" definition of disability?

With any occupation, the insurance company is going to look at, if you can perform a job based upon your education, training or experience with reasonable continuity. For instance, if you were a doctor, you no longer can be a doctor but you might be able to teach, any transferable skill in to another job.

One thing that needs to be noted though, is just because you might be able to do it, the insurance company doesn’t have to show that you are able to get that job, only that there are jobs available usually in your geographic area that you would be eligible to do.

There are 21 opinions so far. Add your comment below.

BW:

CEOs of these for profit insurance companies should have to sign of on each claim that is denied daily.

The reality is they have multiple homes, private jets and as soon as people start to complain about the CEO’s large salaries they will be hidden.

The pace at which discretionary clauses are outlawed and mental health benefits are determined to be discriminatory to be limited to 2 years is ridiculous.

There have been MRI’s for 30 years. The National Mental Health Institute on their website discussed brain scans for healthy brains versus bipolar are different.

It is disgusting how business make money off those unfortunate.

Really there is a huge disconnect with what science is showing with brain scans and the results of law suits.

Every vacation home, private jet etc’ of these CEOs is from blood money.

Congress should be ashamed they allow this to continue. And they are well aware with the law suits and scholarly articles for 20 years.

How utterly shameful and compassionate-less.

Angie:

Can you expound on an any occupation clause after 2 year own occupation, where the plan defines any occupation: based on your education, training and physical ability, one could earn or expect to earn, after 1 year on the new job 60% of their pre-disability earnings before taxes in the national economy.

If one was making 5K a month prior to disability, if there was NO job in the national economy for a sedentary position that would pay 3K (60%) of pre-disability earnings, are you still disabled according to the policy terms?

Can they make you move somewhere in the nation, if they find a sedentary job somewhere, that after 1 year hire would pay you 3K a month? How do they know a job would pay you THAT, in one year?

Very confusing, please help.

Attorney Greg Dell:

Angie, thank you for asking a great question.

The “any occupation” definition can be different in every policy. The any occupation disability definition you have described above has an income qualifier. You are correct that the disability carrier must be able to prove that you could perform a job that pays $3,000 a month. The disability company cannot make you move anywhere in the nation. In most cases they must be able to show that the potential job would be available in your local job market. In order to determine if a job is available they rely on a vocational consultant to perform a Transferable Skills Analysis and a Labor Market Survey. These reports are often biased and unreliable when conducted by the disability carriers. In most cases the jobs they say are available either don’t exist or are not available. Our disability attorneys work with our own vocational experts in order to determine the viability of a job that would be 60% of a person’s pre-disability income. In addition to the amount a job may pay, it is important to take into consideration the physical requirements to perform a job. It is not enough to just label a job “sedentary”. Disability companies like to simplify a job and give it a label of either sedentary, light duty, medium, or heavy duty. Job classifications are not that simple and it is important to prove to a disability carrier the actual job requirements of any job they claim a claimant can perform.

Joe:

I have a related question. My company’s policy has the own occupation for 24 months, then switches to “any gainful occupation which his or her training, education or experience will reasonably allow”. I currently work in finance, have a BA & MBA, and was making approximately 300K/year. I am currently unable to drive, use the computer, read for more than 5 minutes, or handle complicated visual environments. What does any gainful occupation, based on my training, education, or experience mean in this case? For example, does that mean if I can work as a toll-booth worker, I will be denied? Thank you for your help.

Attorney Greg Dell:

Joe,

You have asked a great question. The “any gainful occupation” definition of disability can be subjective. In order to accurately answer your question we would need to research the case law in the state where you live. There are numerous court decisions interpreting “gainful occupation”. A toll-booth worker would not be an acceptable gainful occupation, but the jobs that are selected will depend on the restrictions and limitations documented by your treating physicians. Your disability insurance company will hire a vocational rehabilitation expert to determine what other jobs are available that you could do. You need to plan in advance for the change in definition. Give us a call if you would like for us to review your policy and discuss your options with you.

CB:

1. Are all LTD claimants systematically considered for alternative professions by the various disability insurers as part of the “any occupation” investigation? I especially wonder if older workers might get a bye after a certain age.

2. When sitting is part of the problem, it doesn’t seem helpful to locate another sedentary occupation. Can you share your thoughts on how insurance companies approach this?

Thanks!

Attorney Greg Dell:

CB,

You can find our reply to question #1 here and the reply to question #2 here. Thank you for the great questions!

Debbie:

I have filed an appeal for my long-term disability with SunLife. I believe they are going to deny me, because they always have in the past. I was on long-term for 24 months for depression, anxiety, panic attacks. When the 24 months came to an end, needed to prove that I could no longer work any occupation. I performed a lot of walking in my job and this caused my hip pain become chronic. Also back pain. I filed an appeal to continue long-term disability due to back pain from a bulging disk, chronic hip pain from arthritis and worn cartlidge. I provided them with a doctor statement stating that I could not work due to my physical conditions. I also walk with a cane. During the 24 months I was also awarded my Social Security Disability and recieve a monthly benefit. What rights do I have and should I hire an attorney?

Attorney Stephen Jessup:

Debbie,

As you have already filed your appeal there may be very little that we could do to assist you at this point. However, in the event the appeal is denied, we will be more than happy to review the information to determine if we can file a lawsuit on your behalf.

Deana:

Do I have to fill in the part where I have a side business? Why should this matter? I started the business for supplemental income for my children’s college tuition. If they see I do something on the side, will it be counted against me?

Attorney Stephen Jessup:

Deana,

I would never recommend you submit misleading or dishonest answers with respect to working in a side business as it does broach insurance fraud. If you are working in another occupation by running the side business, then yes, it can certainly be used against you not only to determine if you have the ability to work but also if the insurance company would have a right to repayment of benefits.

Molly:

Hello Stephen,
Thank you for your informative website. What about a diagnosis of dementia. My sister was diagnosed with early onset Alzheimer’s. The insurance company is refused to pay her short term disability for her own occupation and now is continuing to refuse to pay her LTD for any occupation. The truth is that she is incapable of doing anything with any degree of success or continuity. Would you be interested in taking on a case like this?
Marianne

Attorney Stephen Jessup:

Molly,

Please feel free to contact our office with a copy of the denial letters and policies so we can discuss your sister’s claim in detail. We would be more than happy to review the information and provide a free consultation.

Jessica:

I was required to take fmla but because I didn’t intend for it to get to a place where they have offered me long term disability,
I got a medical certificate from a nautropathic doctor and my diagnosis is morgellons/Lyme.

I’m worried because I had no choice but to look for work since I didn’t know if they were going to approve based on the doctor’s decisions.

I am working.

My insurance is long term disability through unum and I don’t know the “any” or “own” occupation status?? How do they expect me to not work and then deny me and expect to make a living?!?!?!!?

Not sure if following through is worth the try with reading about the hurdles and obstacles to obtain long term disability.

Attorney Stephen Jessup:

Jessica, based on the language of your policy, if you are working you may not be eligible for any type of benefit from Unum as some policies only pay if you are completely out of work. If you have a copy of your policy we would be more than willing to review it with you to discuss what your options may be in filing a claim.

Frances:

Good Day,

I have been on LTD for over 12 months. My own occupation 24 months will end 09/01/2018. I was advised by my last case manager that beginning in January 2018 Liberty Mutual will begin collecting updated medical information and as the subsequent months go along I may be required to have an independent medical exam and other procedures they require. To prepare for these issues I have collected all records for 2017 from all my medical providers so I know what is in the records and have adhered to all required visits.

After completing the 24 months own occupation I have 18 months of additional allowed LTD per the employer handbook so long as I am considered disabled. However, the any occupation rule begins October 2018.

SSA declared me fully disabled within 5 months of my initial filing. My primary diagnosis is Rheumatoid Disease (Arthritis) with multiple other co-morbidities. Sadly, none of the expensive biologics have stopped the progression and my PCP has indicated this will continue longer than 24 months. How does Liberty Mutual view this when SSA has approved a person as fully disabled and they are receiving SSDI? Is this taken into consideration? Thank you.

Attorney Stephen Jessup:

Frances, Liberty will be required to take your SSDI decision into consideration when reviewing your claim into the any occupation period. However, receipt of the SSDI is not, in and of itself, a guarantee that Liberty will continue to pay you benefits. Entitlement will still be based on your medical information and doctor support. Please feel free to contact our office if you would like to discuss your claim further.

Sylvia:

My LTD SAY they are going to cut me off after paying me 2.5 years. I tore my shoulder at work and off now 2.5 years. I cannot do anything with my right hand, it’s limited. They want to retrain me for another job, my doctor says I won’t be able to work at all. Everything aggravate my shoulder now, my left shoulder acting up as I now resort to using the left hand. Please can I deny not going to be retrain for another occupation.

Marnia:

Can the insurance company go beyond the medical doctor when he says you cannot work you are totally disabled?

Attorney Stephen Jessup:

Sylvia, most employer provided policies contain work rehabilitation programs. Often the policies will indicate that failure to attend such programs can result in a denial of benefits. You may very well have a duty to try vocational rehabilitation, but it could happen that the program turns you down based on your restrictions and limitations. If your carrier does terminate/deny your disability benefit you would have the right to appeal that decision. Please feel free to contact our office to discuss your claim in greater detail.

Attorney Stephen Jessup:

Marnia, yes, an insurance company can rely on their own medical review to refute your doctor’s and as a way to deny a claim for benefits.

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