What Does “Regular Occupation” Mean in an ERISA Plan?

Many people are surprised to discover that the definition of “disability” can vary drastically depending on the terms and conditions of their long-term disability (LTD) plan. Almost every Employee Retirement Income Security Act (ERISA) plan defines “disability” as a medically-documented inability to work. Unfortunately, it gets a lot more complex from there.

Depending on your LTD plan’s precise definition, you might have to prove that you cannot perform your own occupation, your “regular” occupation, or any occupation. While it’s easy to understand the difference between “own” and “any,” it’s not always clear what the difference is between your “own occupation” and your “regular occupation.”

In this article, we explore how a “regular occupation” clause in your long-term disability plan could impact your claim.

Review Your Plan Document Before You File for Disability Insurance Benefits

Long-term disability (LTD) plans won’t pay your benefits unless you meet a series of complex terms and conditions. Before you apply for LTD benefits, it’s a good idea to review your Plan Document and determine whether you meet its specific criteria.

First, request copies of your Plan Document and Summary Plan Description (SPD). The insurance company should quickly respond to your request and provide the following documents for free.

  • Plan Document: a lengthy formal document that outlines every single procedure and rule that applies to your LTD claim
  • Summary Plan Description: a more concise, digestible document that outlines the key terms and conditions of your plan

However, both documents might contain highly technical language and “legalese” that make them difficult to understand. When in doubt, an experienced long-term disability insurance lawyer can help you interpret your Plan Document and SPD.

In both your Plan Document and SPD, the insurance company should outline how it defines disability. Typically, the insurer will take one of three approaches; you are disabled if:

  • You cannot do your own occupation
  • You cannot do your regular occupation
  • You cannot do any occupation

Most people assume that “own occupation” and “regular occupation” mean the same thing. However, that’s not always the case.

What Does “Regular Occupation” Really Mean in an ERISA Plan?

Unfortunately, there is not a national standard or definition for a “regular occupation.” Instead, different federal circuits have taken different approaches. This means that the definition of regular occupation will vary depending on where you live.

For example, in Nichols v. Reliance Standard Life Ins. Co., the Fifth Circuit Court of Appeals defined “regular occupation” as how the job is typically performed in the national economy — not how the individual or a specific workplace did the job. In Nichols, the claimant worked in a chicken processing plant where she was consistently exposed to cold temperatures; she filed for disability insurance benefits after she developed a circulatory condition that prevented her from working in the cold.

However, the insurance company argued that she could still do her regular occupation. It relied on federal job guidelines called the Dictionary of Occupational Titles (DOT) and said that her “regular occupation” would accommodate her restrictions. This accommodation was impossible at her actual place of employment, but she could arguably work elsewhere. The Fifth Circuit agreed with the insurance company. While Ms. Nichols asked the Supreme Court to review her case, it denied her request.

However, the Third Circuit came to a very different conclusion. In Lasser v. Reliance Standard Life Ins. Co., it defined “regular occupation as “the usual work that the insured is actually performing immediately before the onset of disability.” Therefore, in the Third Circuit, “regular occupation” and “own occupation” are synonymous.

Notably, the Seventh Circuit, which oversees Illinois, has not defined “regular occupation” in an ERISA claim. Therefore, you can anticipate that insurance companies will try to push a more aggressive standard, like they did in Nichols, in our state. For example, insurers might try to misclassify your work in the Dictionary of Occupational Titles so that the job title accommodates your restrictions.

In Nichols, the claimant did not present an alternate DOT job title during the administrative appeal process; they waited until the claim was before the Fifth Circuit. Under ERISA’s rules, the court rejected this late-filed evidence, but you can learn from this unfortunate mistake. To fight back, you and your legal team will need to be prepared with a more accurate DOT classification from the outset and expert opinion from a vocational counselor.

RELATED: Why Vocational Experts Can Make a Difference in LTD Claims

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The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

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