Individuals in Chicago and around Illinois with long-term disability insurance claims get frustrated when the insurer denies the claim asserting the person can sit “frequently,” and stand and walk “occasionally.” They claim that satisfies the ability to work at the sedentary capacity level. Here are a few things you should know when the long-term disability insurer denies your claim on that basis.
Frequently and Occasionally Are Ranges
Doing something at the “frequent” level almost always means, on long-term disability insurers’ forms and in their opinions, doing so between one-third and two-thirds of a workday. “Occasionally” means up to one-third of a workday. As explained in the opinion in our win in Ferrin v. Aetna, those are wide ranges, and without more, they are not very helpful.
The Two Only Equal a Full Workday When the Highest End of the Range Applies
In order to show you can work full-time by sitting frequently and standing/walking occasionally, you would have to have capacity to sit at the top end of the frequent range, and stand/walk at the top end of the occasional range. Long-term disability insurers will nearly always assume, without any explanation, that the top end of the ranges apply.
It Is Not Always Reasonable to Assume the Highest End of the Ranges Apply
Insurers almost never specify where in that range your capacities fall. If your medical evidence shows capacity below those ranges, or at the low end of the ranges, you may be able to persuade a court that the high end of the range is not a reasonable finding. Similar to our Ferrin win, that is what the court did recently in Mulhern v. Life Insurance Co. of North America, No. 17-cv-1758, 2021 WL 1230560 (D. Or. Mar. 31, 2021). When Mulhern sued under ERISA § 502(a), the court considered that Mulhern was awarded Social Security disability, and that the rest of his evidence was consistent with a finding that his capacities were at the lower end of the ranges used by Cigna.
If a long-term disability insurer denied your claim saying you can sit “frequently,” call a skilled long-term disability attorney today.
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