Imagine you have been receiving long-term disability benefits for two years. You have serious back problems, chronic pain, and prescription medications. Your doctors agree you cannot go back to your job. Then a letter arrives: your benefits are ending, because a vocational expert hired by the insurance company has found three jobs you can do.
You have never heard of these jobs. You do not know whether anyone is hiring for them. And you do not believe you could do any of them eight hours a day, five days a week.
Here is how insurers use vocational experts, and what you can do about it.
What a vocational expert does
A vocational expert, sometimes called a vocational rehabilitation specialist or employability consultant, evaluates what occupations you can perform given your medical restrictions, education, training, work history, and transferable skills. Some also look at earnings.
Two things to understand:
- The vocational expert may never meet you. Many of these reports are prepared entirely from documents.
- The vocational expert does not decide your medical limits. The expert works from restrictions supplied by a doctor, often the insurer’s own reviewing or examining doctor. If those restrictions are wrong, everything built on them is wrong too.
The insurer does not have to prove you can return to your old job. Under many policies, it only needs evidence that you can do some other occupation that meets the policy’s definition.
Why this usually happens at 24 months
Many policies pay at first if you cannot do your own occupation, then switch, often after 24 months, to an “any occupation” test: can you do another occupation for which you are reasonably qualified by education, training, or experience? Some policies also require the other occupation to pay a set percentage of your previous earnings.
Example: a 56-year-old warehouse supervisor has serious lumbar spine problems. His job required standing, walking, lifting, and supervising operations. The insurer agrees he cannot do it. At 24 months, a vocational consultant identifies sedentary jobs such as customer service representative and dispatcher, and the insurer decides he is no longer disabled.
His condition did not improve. The definition changed. More: Own occupation vs. any occupation.
How the insurer builds the vocational case
- A medical opinion. The insurer gets a records review or an independent medical exam. That doctor assigns restrictions, for example: sit six hours, stand two hours, lift ten pounds.
- A referral. The insurer sends those restrictions to a vocational consultant, along with your work history and education.
- A job list. The consultant uses occupational databases, labor market information, and job descriptions to identify occupations that fit those restrictions, and may estimate wages.
- A termination. The insurer concludes you no longer meet the definition of disability, even though your treating doctors still support your claim.
The vocational report is only as reliable as the medical restrictions it starts from. If the insurer’s doctor overstated what you can do, the job list will be wrong too.
Where these reports go wrong
Common weaknesses include assuming you can sustain a full workday, assuming skills you do not have, relying on outdated job descriptions, ignoring the policy’s earnings requirement, and looking at each medical problem separately instead of together. Each is covered in detail here: 5 reasons the insurer’s vocational report may be wrong.
Does the insurer have to prove someone would hire me?
Usually not. LTD insurance is not unemployment insurance. Under many policies, the question is whether you have the functional and vocational capacity to do suitable work, not whether a particular employer has an opening or would hire you. Some policy definitions and legal standards give labor market evidence more weight than others, so the exact wording matters.
Age works differently too. Social Security’s rules give special consideration to claimants 50 and older. LTD policies generally do not, although age can still matter in a particular vocational assessment.
What if Social Security already found me disabled?
Social Security and LTD insurers use different standards, and Social Security’s age-based rules usually do not apply to LTD policies. So an insurer can still name other jobs after you win SSDI. But a favorable Social Security decision often contains medical findings and vocational analysis that support your LTD claim. And if your insurer required you to apply for SSDI and took the offset, it should have a reasoned explanation for reaching a different conclusion. More: Approved for SSDI: what happens to my LTD claim?
How to challenge a vocational report
- Get the report. Request your claim file, including the full vocational analysis and the medical restrictions the consultant was given.
- Find the wrong assumptions. Does it assume you can sit six hours when your doctor says three? Ignore your need for breaks? Assume computer skills you lack? Name jobs that require more physical activity than you can tolerate? Misstate your work history or education?
- Strengthen the medical evidence. Ask your treating doctors to state specific limits, with numbers, and to address whether you can sustain work over a full week. A functional capacity evaluation can help.
- Consider your own vocational expert. An independent vocational specialist can write a rebuttal explaining why the jobs listed do not fit your limits, experience, or policy.
- Take the appeal seriously. If ERISA governs your plan, you generally have at least 180 days to appeal, and a court may later review only the record you build now.
Three things to remember
The insurer can agree you have serious medical problems and cannot do your old job, and still stop paying. A vocational report is only as reliable as the restrictions and facts behind it. And an unfavorable report can be challenged, but appeal deadlines are strict, so act promptly.
Was your LTD terminated based on a vocational report? Call 770-351-0801 or request a free case evaluation.
Related: My insurer says I can do sedentary work · What to expect at an IME · Why your approved claim is being reviewed