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What are Material and Substantial Duties in a Long-Term Disability Insurance Claim?

What are Material and Substantial Duties in a Long-Term Disability Insurance Claim?

When evaluating the eligibility of individuals for long-term disability benefits, insurance companies often must determine whether those individuals can carry out the material and substantial duties of their occupations. In some cases, people may differ as to what constitutes a material and substantial duty of a specific profession. As a result, many disability insurance policies, whether they are employer-sponsored plans governed by ERISA or private disability insurance plans, provide a definition of “material and substantial duties” in their plan documents.

In most cases, material duties are those duties that are essential to a particular occupation. An inability to perform the material duties of a job generally makes you unable to do the job. For instance, a surgeon must have the use of his or her hands to carry out surgical procedures. An airline pilot must have excellent vision to fly commercial airplanes.

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What are Material and Substantial Duties in a Long-Term Disability Insurance Claim?

Substantial duties are those duties or tasks that are important in completing some aspect of an occupation or job. Individuals who are unable to perform the substantial duties of their job typically cannot perform the bulk of their duties. For example, if a lawyer has a stroke and no longer can comprehend legal documents, the lawyer is likely unable to perform his or her substantial duties, even if the lawyer physically can appear at work each morning.

Some of the difficulty in defining material and substantial duties of an occupation is in whether the duties are specific to your particular job, or whether they are general duties that people in your profession may perform. In many, if not most cases, the duties that are “material and substantial” to your job may not be the same duties that all people in your profession perform daily. While you may have specific job responsibilities working as a secretary for one company, you may have a different set of responsibilities when working as a secretary for another company. This conflict often can lead to denials of benefits based on a general job description that does not accurately depict your daily duties while on the job.

We know that you are facing disability-related legal issues that can be crucial to your future. As a result, the attorneys at Bonnici Law Group have the skills and knowledge to advise you of all potential options. We know how vital this support can be to you when you are unable to work. As a result, we are here to represent your interests throughout any dealings that you must have with your insurance company. For legal advice about your claim, please contact Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

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