Long Term Disability Insurance – “your job” vs. “your occupation” – understand the difference:

THE VOCATIONAL SIDE OF LONG-TERM DISABILITY

Frequently, long-term disability contracts provide us with definitions for disabling conditions. These definitions embrace the idea that your illness or disability affects your ability to perform “your job.”  Occasionally, policies also refer to “your occupation.” These terms do not mean the same thing.  In many cases we see long-term disability insurers relying upon “your occupation” more than your particular job when they analyze your disability claim.

The term “occupation” embraces how the job is performed in the general economy. Jobs may be similar from company to company, but how that work is performed specifically can vary from employer to employer.

This summer, we had the opportunity to litigate the issue of The Hartford’s policy language as it relates to “your occupation.” After completing the briefing, the United States District Court for the Southern District of Ohio found that the Hartford’s limited manner in which it analyzed our client’s “occupation” was arbitrary and capricious. Specifically, the Court noted that by focusing on 60% of our client’s job, the Hartford failed to embrace the physical requirements that would be required for the remaining 40% of the time that she spent at work.

This is an interesting decision and it demonstrates one of the features of long-term disability work that happens quite frequently. rest This frequently will lead to results that are not appropriate.

We are grateful that the District Court ruled in favor of our client. See  Decision and Order – Calhoun 

Calhoun v. Group Long-term Disability Plan, 3:10-cv-271 (S.D. Ohio July 18, 2011) (reversal of denial of benefits because the plan administrator determined the specific job instead of the occupation, failed to establish the essential duties of that occupation, and failed to consider the employee’s ability to perform those essential duties).

 

Questions about your long term disability insurance claim?

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