Tuesday, April 26, 2011

Disability Redefined

I brought an action against Guardian Life Insurance of America seeking long term disability (“LTD”) benefits on behalf of a woman with rheumatoid arthritis, fibromyalgia, and chronic fatigue syndrome. Guardian agreed to reinstate my client’s LTD benefits. What made this case somewhat unusual is how Guardian’s policy defined disability.

Like most group LTD plans and policies, the Guardian policy defined disability for the first 24 months as being unable to perform your own occupation. However, while most LTD plans define disability as being unable to perform any other occupation thereafter, the Guardian policy defined disability as being unable to perform at least two of six activities of living (“ADLs”).

The significance of the Guardian definition is that after the own occupation period it placed more emphasis on vocational expertise than usual. Whereas an LTD claim
typically revolves around a battle of medical experts, here the focus centered on the findings and opinions of vocational experts. I have no doubt that Guardian would not have reinstated my client’s benefits if she had not retained a vocational expert to rebut the opinions of Guardian’s vocational expert.

The main issue in every LTD case is what does the medical and vocational evidence provide. Unfortunately, I have found that the vocational aspects of LTD claims are frequently given too little attention or are overlooked altogether. That simply cannot be the case in any instance where an LTD plan or policy defines disability based on ability to perform ADLs.

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