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What to Do About the Long Term Disability Insurer’s Characterization of Your Occupation

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What to Do About the Long Term Disability Insurer’s Characterization of Your Occupation

22 Feb, 2021
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I often get calls from long term disability claimants in Chicago puzzled about how an insurer labeled their occupation. Sometimes it happens at the initial claim, but often it happens when the claim transitions from the Own Occupation or Regular Occupation stage to an Any Occupation or Gainful Occupation definition of disability. This generally happens 24 months into receiving benefits. Getting the insurer to correctly classify the occupation has both immediate implications for the claim, and future implications. When insurers classify your occupation, they often use that occupational definition to determine what work experience and skills you have acquired. It is in the insurer’s interest to over-classify your occupation at the beginning of the claim, as that will broaden the base of potential occupations into which the insurer contends you are able to transition and meet the required earnings amount.

In other instances, the insurer may downplay the occupation during the Regular Occupation stage in order to make a denial easier. If you are wondering how to know when an insurer will upgrade or downgrade the occupation, it often has to do with its assessment of your physical functional capacity. But the top takeaway is that the misclassification will generally not be favorable to your claim in the long run.

In a recent case, Joyce v. Life Insurance Co. of North America, No. 18-cv-1293, 2021 WL 493262 (W.D. Pa. Feb. 10, 2021), Joyce worked as a route manager and supervisor for Waste Management. He assigned routes and trucks to workers and performed other supervisory roles. Joyce suffered an injury when a tree struck him in the head during a storm, and he suffered from post-concussive syndrome for a long time after the accident.  For a background on post-concussive syndrome, see this Mayo Clinic article. In denying Joyce’s long term disability claim, Cigna classified his occupation as “Laborer.” Such a classification reduces the extent to which the claimant would have to perform supervisory tasks. Thankfully, after Joyce sued under ERISA § 502(a), the court would not uphold Cigna’s decision to deny the claim and remanded back to Cigna.

If you have made a claim for long term disability benefits and are confused about the insurer’s classification of your occupation, contact a skilled long term disability lawyer right away. The right analysis now could help prevent your claim from being terminated at the transition to an Any Occupation definition of disability.

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