If you have any occupational disability, you may wonder what is the definition of gainful occupation so that you can determine if you are eligibility for long-term disability benefits. This definition can mean the difference between being able to make ends meet while you recover from an injury or illness. To learn more about your specific situation, contact CJ Henry Law Firm, PLLC.
LTD policies generally define disability in one of two ways:
The difference between these two types of policies is important when you’re trying to obtain disability benefits. To make matters more confusing, a policy may shift from an “own occupation” definition to that of an “any occupation” definition for disability after a certain period of time, frequently 24 months.
In both “own occupation” and “any occupation” policies, you must not be gainfully employed to qualify for disability benefits. That means you cannot have a gainful occupation that provides you with at least 60% of the wages that you were making prior to your disability.
Before you can be denied under an “any occupation” plan, the long term disability insurer must prove that you can work at a job that would provide you with at least 60% of your pre-disability employment earnings. They must consider your educational and vocational history when determining whether you can perform those jobs.
The 60% rate is not universal. Some policies require at least a 20% loss in earnings, so you would have to be able to work at a job that provides you with 80% of your pre-disability earnings.
For example, if a surgeon starts having tremors in their hands, they would likely be found to be disabled under an “own occupation” policy because they cannot complete the duties of their own job. However, whether or not they can receive benefits under an “any occupation” plan depends on whether they can perform duties of any other jobs and how much they can earn in those jobs. If their pre-disability salary was $400,000 per year, then the long term disability insurer would have to show that they can obtain a job making at least $240,000, or 60% of their original salary. That amount may be slightly different depending on the plan details.
To qualify for disability benefits, you must show that you are not reasonably suited for gainful occupation. The insurance company will consider your location, skills, education, and limitations. However, the term “reasonably” is often debated. Some factors that may prevent you from being reasonably suited for an occupation to include:
You should submit as much medical documentation as possible to the long term disability insurance company so that they can make a determination considering your medical limitations and other jobs you may or may not be able to work.
Long term disability insurers typically use vocational experts (VEs) to determine other jobs that a claimant may be able to work considering their limitations, the labor market, and other factors. VEs have experience placing people in jobs and understand whether or not a person can perform the duties of many occupations. However, their opinions are not always sound. LTD insurance companies hire their own VEs who may be biased. You have an option to hire a VE as well to testify on your behalf during a hearing.
If your claim is denied based on any occupational disability, then you should contact a disability attorney right away. The attorneys at CJ Henry Law Firm, PLLC can help. Call us today.
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