Your long-term disability insurance company agrees you cannot go back to your old job. But it says you can do sedentary work: sit at a desk, answer phones, use a computer. On that basis, it has denied your claim or stopped your benefits.
Being able to sit in a chair for a while does not mean you can do a desk job eight hours a day, five days a week. Here are five ways to challenge a sedentary-work decision, plus one policy issue that can end the argument on its own.
1. Prove how long you can actually sit
Sitting tolerance is often the central issue. Sedentary jobs involve a lot of sitting, and insurers frequently rely on a medical opinion that you can sit about six hours in an eight-hour day. The insurer’s question is whether you can sit at all. The real question is how long, and what happens when you try to sit through a workday.
Example: a claimant with lumbar degenerative disc disease can sit about 25 minutes before his back and leg pain increase. Then he has to stand for 10 minutes or lie down for 20. He repeats that cycle all day. The insurance company’s reviewing doctor says he can do sedentary work because his arm strength is normal and he walks without a cane. Neither finding says anything about how long he can sit.
Ask your treating physician to write down:
- how long you can sit at one time,
- how many total hours you can sit in a workday,
- whether you need to change positions, and how often,
- whether you need to recline or lie down, and for how long, and
- the medical reason for each restriction.
One caution: not every sedentary job requires six hours of uninterrupted sitting. What counts depends on the occupation and your policy.
2. Explain the breaks and position changes you need
Some jobs allow ordinary breaks and a chance to stand and stretch. Frequent unscheduled breaks are a different matter, and the insurer’s vocational expert may name jobs without considering them.
Example: a claimant can sit 30 minutes, then needs to walk for 10. Every two hours she needs to lie down for 30 minutes. The vocational report lists customer service and data entry jobs, but never says whether those jobs allow her to lie down three times a day.
Document how often you need breaks, what you do during them, and how long before you can start again. Ask your physician to explain why the breaks are medically necessary, then check whether the vocational report considered them.
3. Show how pain, fatigue, and medication affect your work
Sedentary work is not just sitting. It requires concentration, a steady pace, and productivity for the whole day. Chronic pain interferes with thinking. Poor sleep leads to daytime fatigue. Some medications cause drowsiness, dizziness, or slowed thinking. An insurer’s medical review that looks only at your physical exam can miss all of it.
Example: a claimant with severe cervical spine disease takes prescribed pain medication that makes her drowsy. She can sit at a desk, but she cannot concentrate for long and frequently has to rest. The insurer decides she can do office work based on her physical exam alone.
Ask your treating physicians to document medication side effects, fatigue and daytime sleepiness, concentration problems, reduced pace, and how often your symptoms flare. These limitations have to be supported by the medical evidence and match what you actually experience.
4. Challenge the idea that occasional activities prove you can work
Insurers ask whether you drive, cook, shop, clean, or use a computer. They may review your social media or hire an investigator. Then they treat those activities as proof you can work. But doing something occasionally, at your own pace, is not doing it all day on an employer’s schedule.
Example: a claimant says he drives to the grocery store. The insurer reads that as proof he can sit for long periods. In fact he drives 15 minutes, shops briefly, and goes home to lie down.
When you describe any activity, say how long it takes, whether you need help, whether you take breaks, how often you do it, and how long it takes you to recover. And be accurate. Do not exaggerate your limits or downplay what you do. An inconsistency hurts you more than an honest answer. More: Can they cut me off because I drive, shop, or travel?
5. Challenge the vocational expert’s assumptions
The insurer’s vocational consultant usually works from the medical restrictions the insurer gave them. If those restrictions are wrong, the job list is wrong too. Vocational reports can also assume computer skills you do not have, use outdated job descriptions, ignore your policy’s earnings requirement, or skip over attendance, concentration, and breaks.
Example: a 57-year-old warehouse manager with severe lumbar spinal stenosis is told he can work as a dispatcher, customer service representative, or scheduling coordinator. He has little computer experience, cannot sit for long, and needs frequent unscheduled breaks. The report does not address any of that.
Get the vocational report from your claim file and check the restrictions the consultant was given, the jobs listed, what those jobs require, the skills assumed, and the wages. More: 5 reasons the insurer’s vocational report may be wrong.
Bonus: your policy may require more than “any job”
The insurer has to apply your policy’s definition of disability. Many policies switch from own occupation to any occupation after a set period, often 24 months. Even then, many require the other occupation to fit your education, training, or experience, and some set an earnings floor.
Example: a claimant earned $100,000 a year. Her policy says another occupation must pay at least 60% of her pre-disability earnings, or $60,000. The insurer lists desk jobs paying $35,000 to $45,000. Even if she could do those jobs, they do not meet her policy’s definition.
What to do now
- Get the medical and vocational reports from your claim file, and find the restrictions the insurer used.
- Compare them with your real limits: sitting, standing, walking, position changes, breaks, reclining, pain, fatigue, side effects, concentration, and attendance.
- Get detailed opinions from your treating physicians that explain the medical basis for each limit and answer the insurer’s findings.
- Consider an independent vocational evaluation of whether the listed jobs fit your limits, skills, and policy’s earnings requirement.
- Take the appeal seriously. If ERISA governs your plan, you generally have at least 180 days to appeal, and a court may later look only at the record you build now.
If your insurer says you can do sedentary work, do not answer that your back hurts too much. Find the specific medical and vocational assumptions that are wrong, and prove it.
CTA: Was your claim denied because the insurer says you can do a desk job? Call 770-351-0801 or request a free case evaluation.
Related: Top 5 reasons LTD claims are denied · How insurers use vocational experts · Own occupation vs. any occupation · Social Security’s definition of sedentary work is different: see ssdanswers.com