Inexperienced claimants make a grave error when they focus solely on their medical condition when filing a claim for long term disability insurance. This is one of many reasons to speak with an experienced long term disability insurance attorney before filing a claim or when your claim has been denied.
Long-term disability claims succeed when strong evidence of both the medical and vocational aspects of the claim are ready to withstand pushback from a disability insurance company that would rather not pay benefits.
A focus on the physical and mental aspects of the claimant’s occupation is crucial when determining their functional ability to perform their job. For example, a claimant who is suffering from chronic pain due to a failed back surgery must not only discuss their physical restrictions and limitations which preclude them from performing their job (i.e., limited ability to sit/stand/walk), but a discussion of how their pain impacts their ability to focus and concentrate should be discussed as well. A claimant should also discuss side effects of medications which impair their cognition, or other aspects of functionality, due to fatigue or other issues.
The LTD companies will turn to vocational guidelines to determine whether or not the claimant is truly unable to perform the duties and tasks of their job – which they will view as a generic occupation rather than a specific job for a specific employer. This occurs both on the onset of the claim and when the claims period shifts from “own occupation” to “any occupation.”
What is a Vocational Review?
A vocational review is a thorough analysis conducted by an expert to determine the specific tasks of the claimant’s job, based on their job title, responsibilities, education, training, earnings, and work history. A vocational review will also include the ancillary tasks that may not be included in a job description but are part of the job.
For example, a regional sales manager for a pharmacy retailer will need to be physically able to travel throughout their region to supervise workers and processes. Depending on the size of their territory, they may need to travel by car or airplane. If the person has a bad orthopedic injury from an accident and cannot easily walk to a car, sit in a car, drive for more than ten minutes and walk around the retail location, they will not be able to perform the full duties and tasks of a regional sales manager.
The response to this kind of scenario from a disability insurance company is often to point out the person can still use the telephone and computer and so there are other jobs the person can perform. However, a person who cannot sit for more than a few minutes in a car is not likely to be able to sit in front of a computer at a desk, making it next to impossible for them to work at this or many other jobs.
The vocational expert will provide detailed evidence on all of the tasks necessary to perform in a job and analyze how the person’s medical condition impacts their ability to perform such tasks.
What is a TSA—Transferable Skills Analysis?
The vocational evidence is further supported by a TSA — Transferable Skills Analysis. The TSA is a series of tests performed by a vocational rehabilitation expert used to determine what other jobs a claimant could perform, based on their knowledge, work experience, education, and other kinds of training. Often, prior skills once learned, even if now stale, will be credited by the insurer in a TSA, to the claimants’ detriment.
Be careful if you are asked to complete a questionnaire as part of the TSA. Remember the point of the questionnaire is to see if you are able to work in another job, not to learn if you are a good sport who is willing to be flexible and open to another field of work. And you are not looking to brag, as you are not seeking work.
The TSA also addresses the following:
- Labor market research to identify what other vocations might be suitable, or any employers who “might” be hiring—not whether you could be hired;
- Determination of the person’s capacity before the injury or illness caused them to be disabled;
- Determination of the person’s capacity to work after the injury or illness caused them to be disabled.
TSAs will seek to match the capacity of the individual and whether their skills are transferable to a different job than the one they were previously performing.
The goal of the TSA is to create an objective view of what kind of employment a claimant might pursue if they are no longer able to perform the material tasks and duties of their occupation.
When Does a Disability Claim Change from “Own Occupation” to “Any Occupation”?
Both TSAs and Vocational Reviews are used in the initial evaluation of a long-term disability claim and when the disability insurance policy switches from “own occ” to “any occ.” Every disability insurance policy is different, but a careful review of the policy will show when this occurs. For most policies, the switch comes at two years or twenty-four months of long-term disability insurance benefits. Often, the analysis will begin months prior to the change in definition date—allowing the insurer to terminate benefits “as of” the transition date.
At this time, the person is considered to be able to work in another occupation, even if they cannot perform the material and substantial duties of their own occupation. And while it’s not easy to navigate and every case is different, the above principles should help to guide claimants.
If your long-term disability insurance policy company has denied your benefits or has terminated your claim, call us at 877-583-2524 for a complementary phone consultation and discussion of your policy provisions.