What if the Long-Term Disability Insurance Company Uses an Inaccurate Job Description to Deny Benefits?

Judges have ruled that all denial letters must start with an accurate job description. This is the first place that we look to nab insurance companies. If the whole claim analysis has been done based on the idea that you have a sedentary job when, in fact, it is significantly more physically demanding, the entire rest of the claims process will be wrong. Becoming wheelchair bound may not disable someone from their desk job but it certainly can disable them from driving a forklift or loading trucks.

We recently represented a woman whose benefits were denied because her insurance company, Lincoln, said she was capable of performing a sedentary job. Well, that was true: her disability did not affect her ability to perform a sedentary job. Unfortunately, her job was not sedentary. Lincoln had multiple memos from her supervisor and Human Resources department stating that her job description included lifting 25-30lbs daily, walking 2-3 hours per day, and standing a significant portion of the rest of the day. This is classified as a “light duty” occupation.

Our client’s disability was related to an injury of both feet, which required surgery followed by an extended rest and healing period. She was approved for short term disability through Lincoln, which covered the surgery for one foot, but when she applied for long term disability, she was denied. Somehow, whether through negligence or deliberate misrepresentation, Lincoln substituted her job title with a total mismatch from the Dictionary of Occupational Titles (DOT) and told everyone reviewing her claim that her job was sedentary. Accordingly, they found that she was capable of performing a sedentary job and used that as a basis to deny her claim. Had these same reviewers considered her injury in context of a light duty job, they undoubtably would have found her disabled.

An accurate job description must be the basis of a disability determination. Lincoln was either careless or malicious in substituting our client’s job description for one that allowed them to deny benefits.