What Are “Substantial and Material” Duties of My Own Occupation?

What Are “Substantial and Material” Duties of My Own Occupation?

Long-term disability plans typically measure whether your medical condition prevents you from doing either your own occupation or any occupation. In some cases, the eligibility criteria changes from own occupation to any occupation after the policy has paid out benefits to claimants for a specific period, such as two years.

In many “own occupation” long-term disability policies, eligibility for benefits is based, at least in part, on your inability to perform the “substantial and material” duties of your own occupation. Claimants need not be helpless and unable to perform daily activities. Instead, they must be incapable of performing essential tasks necessary to complete their jobs effectively and successfully as a result of their medical conditions.

These tasks usually include the tasks that the claimants were performing at the time that their disability arose. However, the definition of “own occupation” can differ from one policy to the next. Some policies may attempt to define these tasks as those that employers would reasonably and usually expect employees to complete with the scope of their occupations.

Defining what exactly constitutes “substantial and material duties” of your own occupation also might vary among policies. In most cases, these are tasks, functions, and operations that you must regularly perform to do your job. It also can refer to the skills, abilities, knowledge, and training required by employers for your specific occupation. “Substantial and material duties” usually cannot be modified or eliminated from the job, since they are essential to completing the job.

All too often, insurance companies may disregard the tasks that you regularly perform as a function of your job. Instead, they may consider the tasks that an employee in your occupation in the general economy would perform. The tasks that your profession in the general economy might require can be quite different than those that your specific job would require. In many cases, the general tasks may be significantly more accessible than those that you performed daily before your illness or injury. The insurance company could use this analysis to conclude that your medical condition does not prevent you from performing these essential tasks. As a result, the company may rule that you are not entitled to disability benefits.

Bonnici Law Group provides client-focused representation throughout the ERISA claims process. We are here to consider the evidence in support of your ERISA long-term disability claim and evaluate your application. Next, we can develop the most effective strategy for fighting any denials of coverage that you may receive. Allow us to handle your legal needs while you focus on your physical and emotional health. Contact the ERISA long-term disability attorneys of Bonnici Law Group at 619-259-5199 or help@bonnicilawgroup.com.

Write a Reply or Comment