How Do Insurance Companies Define Your Occupation for Long-Term Disability Benefits?

A long-term disability insurance company cannot define your occupation for you.

Long-term disability insurance policies typically pay a benefit if, through injury or sickness, you are no longer able to perform the material duties of your occupation.  Insurance companies will often try to "generalize" your occupation so that it will be easier to deny benefits.

A recent case out of the federal court in Virginia makes this point.

The claimant was a wine salesman for a distributor and his job required him to deliver cases of wine weighing more than 20 pounds to stores and then to stock the shelves and create store displays.  Moreover he drove about 2,000 miles per month.  He suffered a back injury.

Liberty Life Insurance Company sought to "redefine" his occupation.  Rather than looking at what he actually did for a living it defined the claimant as a "sales representative" and thus evaluated his job as one requiring only a light level of exertional demand.

The court said that this was a wrong.

  • The court said that the insurance company must review the material duties of the claimant's particular position and make an assessment of how those duties align with the position as it is normally performed in the national economy. 
  • The court found that Liberty and its vocational evaluation disregarded the physical demands of the claimant's occupation. 
  • Since Liberty had the physical demands listed in the job description the court said that "When the physical demands are laid out in detail in a nineā€‘page document" one cannot simply generalize the occupation to "sales representative." 
  • The court also noted that Liberty's internal files called the occupation "heavy." 
  • Finally the court said that the fact that the vocational evaluator was someone inside of Liberty "was a part of Liberty's structural conflict of interest."

Long Term Disability Tip: When doing an appeal of a denial of benefits, you must make all of yoru legal and factual arguments and put in all of your evidence. A long-term disability specialist can put your in the best position to make your arguments.

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