What Does Gainfully Employed Mean? Common Issues in Disability Insurance Disputes

Posted on September 26, 2018 by cjblog

One of the common issues that arises in disability insurance disputes is whether or not a claimant meets the definition of gainfully employed. It might sound like a simple concept; however, your insurance company may use very technical terms. When working through disability insurance disputes, you should work with an attorney who can help you through the process. The insurance company has specialized knowledge, and they may use a legal team to manage your case. You deserve to have a legal professional on your side too. Call CJ Henry Law Firm today to find out how a disability lawyer can help you.

Long Term Disability Policies Define Disability in One of Two Ways

Disability insurance companies often define disability to mean you are unable to work. However, sometimes insurance companies consider inability to work your own occupation and sometimes they consider inability to work any occupation. It’s important to determine which type of policy you have.

If your insurance policy is an “own occupation” policy, then you must prove that you are unable to complete the duties of your own, or current, employment position.

However, if you have an “any occupation” policy, then you must show that you cannot be gainfully employed in any occupation. Disability insurance disputes often arise over the definition of gainful employment.

What Does “Gainfully Employed” Mean?

In most situations, “gainful” employment is that which amounts to at least 60 percent of your wages prior to becoming disabled. Thus, in disability insurance disputes, you must show that you are unable to obtain employment that would amount to at least 60 percent of your pre-disability wages. If you are not able to complete such work, then you have meet the definition of disabled.

Not every insurance company uses the 60 percent figure; however, most use a number that is close to that. If you are only able to make 40 percent of what you made pre-disability, then some insurance companies will pay you the remaining 20 percent. However, the details of how you meet the gainfully employed definition depend on your disability insurance policy.

When dealing with disability insurance disputes, it’s best to work with an attorney. Your attorney can help you prove that you do not meet the gainfully employed definition and you are not able to obtain gainful employment.

You Must Be “Reasonably Suited” to Perform a Gainful Occupation

In determining whether you can obtain gainful employment, they must prove that you are reasonably suited to perform a gainful occupation. This determination will consider your location, skills, education, and physical and mental limitations. However, in disability insurance disputes, there is often a question about what “reasonably” actually means. Some factors that would make it “unreasonable” for you to perform in an occupation include:

  • There are little or no positions of a certain type within a reasonable distance from your home;
  • The requirements of the job are beyond your education level and skill ability;
  • You would not be able to attend regular doctor’s appointments with the job; and/or
  • Your doctor has not released you to perform the tasks required of the position.

When dealing with disability insurance disputes, the insurance company will likely try to prove that you are reasonably suited for gainful employment. However, with the help of your attorney, you can show that you are unable to become gainfully employed.

Vocational Experts in Disability Insurance Disputes

It may seem like it’s your word against theirs when it comes to disability insurance disputes. However, vocational experts (VEs) can determine if you can become gainfully employed and whether you are reasonably suited to perform a gainful occupation.

VEs understand the economy and often specialize in your field of work specifically. They may have read your medical records and reviewed information about your prior jobs, skills, education level, and more. A VE should be able to compile information from government agencies to determine if there are any reasonable jobs for you to work within your geographic location.

However, VEs sometimes make decisions that are contrary to that of your doctors. For example, let's say your doctor says you cannot sit for longer than two hours at a time. But a VE determines that you can work a sedentary job for eight hours a day. In that case, there may be a discrepancy in the VE's determination. In these types of disability insurance disputes, it’s important to work with an attorney. She can help provide information that updates the VE's decision. You may also have to obtain an opinion from an additional VE.

Speak to a Disability Attorney Today

If you have questions about disability insurance disputes or have questions about whether you fit the definition of gainfully employed, speak to a knowledgeable disability attorney. Call CJ Henry Law Firm today.

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