Sedentary Work and Long-Term Disability Claim Denials
Long-term disability (LTD) claims involving sedentary work can be especially challenging for claimants. Insurers may deny a claim on the basis that the decreased physical demands of the job mean medical conditions are less likely to interfere with a claimant’s ability to work. Yet this is usually not a fair assessment of these claims.
In this article, we will discuss sedentary occupations, how medical conditions can impair one’s ability to perform sedentary work, the most common reasons that insurers deny these claims, and ways that claimants can respond.
What Is a Sedentary Occupation?
A sedentary occupation is where you spend most of your time sitting. For LTD purposes, this is commonly defined as at least six hours of sitting per workday. Some walking and light lifting may be necessary, but strenuous labor is not expected.
Generally, professionals in these occupations must retain the use of their hands and cognitive abilities. Some common duties of sedentary work include typing and notetaking, working at a desk, and concentrating for extended periods.
Examples of sedentary occupations include:
- Data analysts
- Marketing professionals
- Business consultants
- Administrative assistants
- Legal professionals
How Can Medical Conditions Impact Sedentary Work?
While insurance companies may argue that sedentary work is possible with a medical condition—and therefore ineligible for LTD benefits—this is not always the case. Many medical conditions can prevent a person from performing the duties of a sedentary position.
For example, if you suffer from ankylosing spondylitis, which is an inflammatory spine disease that causes back pain, then you may not be able to sit for extended periods. Back pain can make it difficult or even impossible to sit or concentrate for any amount of time.
Likewise, any condition that affects your cognitive abilities can impair your ability to work a sedentary job. A form of dementia can make it impossible to concentrate or remember the work you are doing. Similarly, conditions like post-concussion syndrome, sleep apnea, bipolar disorder, and insomnia can all impact your cognitive abilities.
Other conditions, such as irritable bowel syndrome, can cause stomach cramping and abdominal pain that can also inhibit your ability to complete the tasks of your job properly.
For example, irritable bowel syndrome may cause you to be away from your workstation frequently throughout the day, which can impact task completion.
Similarly, if you must analyze data but are more focused on the pain and discomfort you are experiencing, then you may make mistakes or leave analyses unfinished.
Why Do Insurers Deny LTD Claims Involving Sedentary Work?
To receive long-term disability benefits from your insurer, you must prove that your condition meets your policy’s definition of disability. This definition will typically either be an “own occupation” or “any occupation” definition.
Under an “own occupation” definition, you typically must prove that you are unable to perform the job you were doing prior to your disability, which may have been a sedentary position. Under an “any occupation” definition, generally you must prove that you cannot perform any job whatsoever. Insurance companies often consider sedentary occupations to be the least demanding type of work. As such, they often believe that claimants can perform at least these types of jobs.
There are several reasons insurers may come to this conclusion. For example, when filing for LTD benefits, your doctor must fill out the Attending Physician Statement (APS). On the APS, there is a section about the level of work you can perform. Often, these forms do not have a lower category than sedentary work, so your doctor may feel forced to misrepresent you as able to perform sedentary work, which can lead to claim denials.
Another common reason insurers deny claims involving sedentary work is because they may improperly define your occupation. Insurance companies routinely reference the Dictionary of Occupational Titles (DOT) and the O*Net Database to find the duties of various occupations. These resources are not always reliable and often outdated, particularly given that sedentary work has evolved significantly over the years due to technology and other factors.
These resources also do not always fully encompass the cognitive demands of various occupations. As a result, your insurer may deny your claim without accurately considering your occupation’s actual duties.
What To Do if Your LTD Claim Is Denied Due to Sedentary Work
Claimants have the right to appeal when insurers deny claims involving sedentary work. They should consider the following steps:
- Research their LTD policy. Policies will outline the definition of disability you need to meet to receive benefits and other important provisions that apply to your claim.
- Obtain reports from their physician. Detailed statements from your medical team, explaining the impact of your disability on your sedentary job duties, can help counter your LTD insurer’s arguments.
- Document their disability. Careful records of how your medical conditions impair your ability to perform sedentary work can prove highly useful. It is important that you are fully and accurately describing your symptoms and resulting impairments to your treatment providers. Keeping a symptom journal can also act as supplemental evidence for your appeal.
- Hire an LTD attorney. Insurers have extensive experience and resources, and if they choose to dispute a claim involving sedentary job duties, it can be extremely valuable to have a well-equipped advocate on your side.
Call Chisholm Chisholm & Kilpatrick Today
If you received a denial for your long-term disability claim due to your sedentary job duties, then you have the right to file an appeal.
CCK has helped hundreds of LTD claimants over almost 30 years. Our team works tirelessly to hold insurers accountable, ensure claims are compliant with ERISA, and increase the chance of success for claims. We are better equipped to secure and maximize your benefits, freeing you to focus on your health.
Call us today at (800) 544-9144 for a free case evaluation with a member of our team.
