All too often we see denials of disability claims which contain vague terms advising insureds that there was a lack of “objective medical evidence” to support a claim that he or she cannot perform their “sedentary occupation.” The average insured, who has never made a prior disability claim does not understand what this means and how to effectively rebut this contention during an appeal.
Insurers may claim that they consider “subjective evidence,” i.e., a claimant’s reports of pain, numbness, headaches, etc., however, what they are really looking for is “objective proof” that the condition is actually disabling a claimant. In some instances, the disabling symptom, such as pain, is difficult to quantify. It is helpful to attend an examination, such as Functional Capacity Examination where a claimant’s ability to perform work related tasks is measured by a neutral professional. Or, in those claims where cognitive impairment is an issue, it may be helpful for the insured to undergo neuro-psychological testing to document that there is difficulty in executive functioning or memory. In claims where symptoms are erratic, a claimant should keep a log of symptoms and report what he or she cannot do during any given day as proof that impairment has curtailed their activities.
Some of our clients have also been confused when they first receive a denial letter which advises them that the insurer has determined they can perform their “sedentary occupation.” Our clients’ confusion is understandable because their policy provides benefits if they are unable to perform their own occupation and/or another occupation which is suitable in view of their education, training and experience. Our clients express frustration because their job may not have been just a “desk job” as there were physical and mental requirements other than just “sitting at a desk.”
The reasoning utilized by insurers is not apparent from the denial letter, but can be gleaned from the claim file. Insurers use “vocational experts” who classify jobs as “sedentary, light, medium or heavy.” They focus on only the sitting, standing, walking, pushing and pulling requirements of a job; often ignoring cognitive demands and fine manipulation tasks, such as typing. Using only the “sitting, standing, etc.” requirements of a generic sedentary job, the insurer than determines that if the insured can perform those generic requirements, he or she can perform any sedentary job.
It is important, during the appeal phase of any disability claim, to submit evidence that rebuts these reasons for denial. In instances where the insurer is claiming a lack of “objective evidence” to support a claim, an insured should submit evidence that the pain and/or symptoms have truly interfered with his abilities. If the insurer has claimed that an insured can perform a generic “sedentary” job, the insured should submit evidence, such as a job description, supervisor statements, etc., which explain the true requirements of the job he or she performed. It is imperative that this information be submitted during the appeal, because in a subsequent trial, a judge may never see that evidence if it is not contained in the insurer’s claim file.