Any occupation investigations are haphazardly done by ill-advised claims handlers, vocational reps, Genex, and other third-parties. As the insurer’s last hope of denying claims to avoid costly liabilities, the “any occ” process, is so out-of-touch with reality that “garbage-in, garbage-out” is usually the norm.
Most ERISA Plan readers are already familiar with the “change in definition” and how after 12, 24, 36, or 60 months, claimants must prove they are unable to work at all. This definition is the same as that for SSDI, which states “inability to perform any occupation in the national economy.”
Insurers just aren’t good at performing “any occupation” investigations, if they perform them at all. In fact, if it is clear claimants have no “transferable skills”, in many incidents, “investigations” aren’t performed at all. Most ERISA folks, however, have no idea what goes on inside the insurance company during an investigation and unfortunately many claims are denied based on a botched or mishandled internal procedure.
Claims are referred to an internal or external third-party vocational rep with CRC (Certified Rehabilitation Counselor) credentials. This people have access to computer software that evaluates occupations. The software used is grossly outdated with the most recent update completed in 1979. Occupational listing are incomplete, and most insurance companies have not updated to more modern data bases. The DOT (Dictionary of Occupational Titles), although still used, is also grossly outdated.
In addition, many ERISA claimants are unaware that “job” and “occupation” are two different things. ERISA Plans DO NOT insure “jobs” only “occupations” as defined in the national economy. And, where are the definitions? In the DOT and other grossly outdated data bases. So, coming out the gate, any occupation investigations are flawed and inaccurate from the beginning.
Most ERISA Plans today include the term “indexed pre-disability earnings”, a Plan provision most claims handlers know nothing about. This wording requires a computation using the Consumer Price Index (CPI) to take inflation into account.While in the past four years the US economy was not in a state of inflation, it looks like the country may be headed for just that.Therefore, in the coming years it will be extremely important for claimants to look for documentation that “indexing” was computed to determine if occupations are “gainful” or not.
Moving forward, it will be extremely important for claimants to “manage” the any occupation investigation process by providing as many patient notes and medical information as possible when notified the process has begun.This isn’t a process that should take place without intervention from claimants themselves. If garbage is put into the process then only garbage will come out.
During COVID, insurers were not able to take advantage of the “profitability” aspects of other risk management activities such as surveillance and field visits, and therefore, they resurrected any occupation investigations with new interest. This doesn’t mean the any occ process is more efficient, it just means insurers are pursuing it more often because it doesn’t involve any direct contact.
The important message here is that claimants pay attention to the “any occupation” dates and manage the process in lieu of just turning it over to the insurance company. Insurance companies DO NOT manage the process well, and if left to their own devices will deny claims unfairly with a faulty process.
If you have any questions concerning “any occupation investigations”, or any other topic related to disability claims, please feel free to contact me for a free consultation.
My website is located at: http://www.disabilityclaimssolutions.com or please call me at 207-793-4593. I’m here to assist you when you need it.
Email: DCS@metrocast.net
