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UNUM Disability Denial: Louisiana Court Reverses UNUM for Changing Job Description During Claim Appeal

Disability Policy Describes How Insurance Company Picks Duties of Job to Assess Disability

An important aspect of disability benefits is determining whether or not the claimant satisfies the disability insurance policy’s definition of disabled. Many disability policies require an insurance company will find a claimant disabled if they are no longer able to perform their current occupation. Thus, the insurance company is required to review the claimant’s medical records in light of his job description to determine whether or not he is considered disabled under the insurance policy’s definition of disabled. But what happens when the insurance company changes the rules of the road mid-claim and uses a different job description?

What Job Description Does the Disability Insurance Company Have to Use?

The insurance company typically relies on the job description provided by the claimant upon applying for disability benefits. But, the disability insurance policy language may also reference an outside source to identify the duties of a job. One common source is a publication of the U.S. Department of Labor known as the Dictionary of Occupational Titles, or DOT. The DOT references nearly all jobs in the economy and denotes what particular characteristics are required for the job in particular. The Dictionary of Occupational Titles also states the strength requirements and skills that are required for an average person to perform the requirements of the particular job.

Insurance companies will reference the Dictionary of Occupational Titles where there is uncertainty about what a claimant’s job may require. They may also use the DOT when the job description provided by the employer is more strenuous than the disability insurer thinks the job should be. In the case, the DOT may information may allow them to deny a claim easier.

What Happens When the Disability Adjuster Uses Two Different Job Descriptions?

Generally, your disability insurance company may not apply the Dictionary of Occupational Titles job description if the disability consultants handling the claim previously made a decision on your claim using a different, less stringent, job description.

A recent case involving the large disability insurance company UNUM illustrates this point. In Marcades v. UNUM Life Insurance Company of America, a lawsuit filed in the U.S. Eastern District of Louisiana, Terry Marcades, a pest control sales agent, applied for disability benefits after his work truck was hit from behind in a high-speed crash. He was awarded disability benefits based on medical reports noting that Mr. Marcades was “totally disabled due to cervical disc disease with a bilateral C7 radiculopathy as well as ulnar entrapment of the elbow.” In making this decision, UNUM’s vocational consultant identified his specific occupational requirements as “frequent kneeling, stooping, crawling (40-50% job duties [sic]” and that “[c]rawling is required in virtually all residential inspections.” The job description that UNUM got from the employer was clearly a strenuous job that Mr. Marcades could not perform due to his medical condition.

Shortly thereafter, Mr. Marcades required surgery on his back. His doctor then allowed for him to return to work as long as he did not lift more than twenty pounds. UNUM then terminated Mr. Marcades disability benefits. He quickly appealed the decision, but during the appeal process, UNUM did not use the employer’s job description.

Instead, UNUM referred to the Dictionary of Occupational Titles to identify Marcades job description as a Pest Control Salesman. After UNUM referenced the Dictionary of Occupational Titles, it based its continued denial of benefits on the newly referenced occupational description—a much less stringent standard than previously used when making decisions.

The federal judge hearing the case held that changing the job description on appeal was improper. The court held that an insurance company may not rely on the Dictionary of Occupational Titles when making a determination on appeal, after having applied a more demanding job description for Mr. Marcades earlier in his claim.

Takeaway – UNUM Not Allowed to Change Job Description

Your disability insurance company may not rely on different job descriptions during your claim. They must choose an accurate set of job duties as allowed by the disability policy, and stick with that job description.

 

Case: Marcades v. UNUM Life Insurance Company of America, No. 15-1144, 2016 WL 4418807 (E.D.La. 08/18/2016)

 

If you are fighting UNUM or another disability insurance company that has denied your disability insurance claim, call our experienced Disability Insurance and Bad Faith Attorneys at (866) 282-5260 to discuss your rights.

 

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