Disability Insurance Policy Definition: Your Occupation
Many disability insurance claims are wrongly denied based on the insurance company not using the correct physical or mental demands of an occupation. What are the main duties of your day-to-day work? For example, do you have a job that requires heavy-lifting or do you most often sit at a desk (sedentary work)? What are the cognitive demands of your job?
When a claim for long-term disability is filed, the insurance company will have someone analyze and evaluate your job. This person, who is called a vocational specialist, will review your occupation and write a report outlining your job duties and responsibilities. Their analysis may come from your own statement about your job, your employer’s description of your job, or a database with general information on jobs. The insurance company uses this report to classify your job in one of the following physical demands category: sedentary, light, medium, or heavy.
Unfortunately, this is where problems arise. Use of all these different sources can lead to the misclassification of your occupation. In a fair world, the insurance company would evaluate what you actually do day-to-day and then classify your job. But that is not always the case.
Your long-term disability insurance policy is what determines how the insurance company should classify your job. Sometimes, insurance companies do not follow the policy and classify your job in a way that is better for them. All long-term disability insurance policies have a provision which explains what “disability” and “disabled” means. When the disability policy has a definition of disability based on “own occupation” or “his/her regular occupation,” the use of the words “own” or “his/her” mean the usual work you were doing at the time you became disabled.
For instance, if you are an operating room nurse, the insurance company should consider all aspects of your duties as an operating room nurse. It should not just say you are a nurse as defined by the national standard for a nurse. The day-to-day work of an operating room nurse and a nurse at a pediatrician’s office are very different. Those occupations should not be categorized the same way. Yet, that is what insurance companies try to do.
We have seen more and more insurance companies use language to alter the meaning of “his/her” or “own.” This is done by adding a national standard to how jobs are performed. If a disability policy has a “national standard” provision, then your job or occupation might be classified in a way that makes it more difficult for you to prove you are disabled.
Insurance companies improperly classifies people job using the national
standard. According to the law, if the policy says “own occupation”
or “his/her regular occupation,” then the insurance company
should use only what that person actually does when classifying the job.
Understanding what your policy says about classifying your occupation is the first step. If your benefits were denied because your job was misclassified, you may have strong grounds for appealing or even filing a lawsuit.
Having an experienced attorney help you with your claim and/or appeal is beneficial because they will be able to confirm that a proper classification of your job is used when determining whether you are entitled to long-term disability benefits.