How The Insurance Company Uses The “Vocational Expert” To Support A Denial

Insurance companies use a “vocational expert” to assist them in denying claims. Rather than assess whether the policyholder is able to perform his or her actual job as reflected in an accurate job description or a fair analysis of the actual functional requirements of the job, the “vocational expert” is enlisted to redefine the policyholder’s job. By redefining the job to be something it is not, the insurer can far more easily deny the claim and provide a disingenuous justification for its denial.

Among the techniques commonly used by the insurance company’s “vocational expert” in drafting memos or reports to assist insurance companies in denying  claims are as follows:

  1. Using the Dictionary of Occupational Titles, a publication of the federal government, last updated in 1999, to describe the occupation performed by the policyholder rather than the policyholder’s actual job description — which is likely to reveal a far more demanding job.
  2. Describing the demands of the policyholder’s occupation solely as “sedentary” and disregarding or minimizing the cognitive demands of the job — more particularly, for example, disregarding the need for the policyholder to sustain focus and concentrate for prolonged periods of time on complex and detailed subject matter, multi-task, speak at meetings of co-workers or speak and interact in public forums and perform other complex and demanding tasks that far exceed the mere ability to sit.
  3. Disregarding in their analysis that policyholder, in the real world, is required to perform his or her job duties “with reasonable continuity” and in the “usual and customary way” — as recognized in the California definition of “disability” or “total disability.”
  4. With regard to physicians applying for disability benefits, mischaracterizing the actual occupation duties of the particular physician — for example, mischaracterizing the nature of the surgical procedures he or she actually customarily performed, the physical and cognitive demands of such surgeries, and the functional requirements of conducting a particular office  practice.

In fairness to the “vocational expert” — who is usually an employee of the insurance company, these techniques designed to deprive the deserving policyholder of disability benefits originate in the insurance company. The “vocational expert” is just another cog in the insurance company’s denial mechanism.

Posted by Bennett Cohen on 4/11/16.

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How The Insurance Company Uses The “Vocational Expert” To Support A Denial

appeared first on San Francisco Top Disability Attorney and Insurance Claim Denial Law Firm.


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