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How Does My Insurance Company Consider My “Education, Training, and Experience” in Evaluating My Long-Term Disability Claim?

How Does My Insurance Company Consider My “Education, Training, and Experience” in Evaluating My Long-Term Disability Claim?

In many long-term disability insurance policies, eligibility for benefits initially is based on your inability to perform the essential tasks of your “own occupation.” In other words, you meet the definition of “disability” for these benefits if your medical condition prevents you from carrying out duties required for your current occupation.

After a specified period, however, it is not unusual for the definition of disability to change. After receiving 24 months of benefits, for example, you may be unable to continue receiving benefits unless you meet the new definition of disability. In many cases, you become ineligible for further long-term disability benefits unless you can show that you are unable to perform the tasks of “any occupation.” This is the point at which your “education, training, and experience” becomes relevant.

Many policies state that “any occupation” refers to any occupation for which the claimant is reasonably suited based on “education, training, and experience.” While all policies may contain slightly different language, this standard requires an inquiry that is unique and fact-specific to each claimant. This inquiry should consider the claimant’s age, educational background, and level of training at that the time that they stopped working. Any limitations or restrictions that the claimant has due to illness or injury may impact the ability to perform the duties of any relevant occupation.

Furthermore, in many cases, the policy may require that the proposed alternative occupation be similar in nature, status, and compensation to the occupation that the claimant was working in before the illness or injury. Therefore, it may not be reasonable to expect that a human resources manager begin working as a fast-food worker. Although the claimant might be able to perform the duties of the fast-food job, it would not be similar in nature, status, and compensation to the previous occupation.

Long-term disability claims are complex matters that require intensive knowledge of ERISA laws and regulations. As a result, you will need experienced legal representation and advice to pursue an ERISA-governed disability claim. Bonnici Law Group is a law firm focusing on ERISA long-term disability benefits and bicycle injury cases in San Diego, CA. When you need effective legal representation, contact Bonnici Law Group at 619-259-5199 or email us at help@bonnicilawgroup.com.

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