That's Kind Of The Point of Long Term Disability Insurance, Isn't It?
You get hurt or have a serious illness and you can't work. You're not faking, scamming, or anything else. So you would think that if you can't physically do the real job duties your position and your boss require you to do that would be enough - you would be able to get benefits under your employers long-term disability policy.
But most employer-sponsored long-term disability insurance policies don't think that (they are written with the insurance company in mind, not the person struggling with the injury or disease). Many disability insurance policies will define “disability” in such a way that makes it really hard, almost impossible, to succeed with their claim and recover benefits.
Here's an example - in one reported court case, the worker was the director of commercial security operations and he made a claim for disability benefits under his employer's long term disability plan.
This worker, like most people would, assumed he was protected if he couldn't physically perform the duties of his job - his "own occupation" as most policies call them. But the disability insurance policy his employer had purchased didn't define it that way - instead, it provided benefits only if the worker could not perform the duties of the occupation as that occupation is performed in the national economy.
Think about that in the context of your own work experience - there can be a huge difference between a corporate job description and what you actually do on the job. This is an even more sanitized, vanilla version.
Since his actual job was apparently more physically demanding than it was in other places, or generally around the country, his claim for disability benefits was denied. He appealed his claim but the court upheld the finding of the disability insurance company.
The case is called Hankins v Standard Ins. Co., (8th Cir, May 14, 2012)
If you’ve received a denial letter from your employer’s insurer, give us a call at (202) 393 - 3320 and we’ll be happy to help. Watch this video to get more information on how it works.