Proving You're Unable To Obtain Gainful Employment

One of the requirements for being approved for long-term disability is you must be unable to obtain gainful employment. However, the definition of gainful employment can vary depending on the insurance company and policy. Here's what you need to know about this requirement to help you qualify for benefits.

Understand the Company's Definition of Gainful Employment

The first thing you need to do is study your long-term disability insurance policy and determine if it defines gainful employment by whether you can get a job in your own occupation or any occupation. This subtle difference in wording can make a big difference in your ability to collect benefits.

If your insurance company determines your eligibility based on your ability to obtain gainful employment in your own occupation, the company will evaluate whether you can get a position in an industry you were trained for or the same type of job you left when you were disabled. For instance, if you were trained in computer engineering, the insurance company will evaluate your case to determine if you can continue to be employed as a computer engineer.

On the other hand, an "any occupation" requirement bases your eligibility for benefits on whether you can obtain any employment based on your skills, education, and experience. For instance, even though you may not be able to work as a computer engineer any longer, you may still qualify for a job as an office assistant.

It may be easier to qualify for benefits under an "own occupation" policy, as you can provide a list of the requirements of the job and show how your disability makes it difficult to perform the tasks. With an "any occupation" policy, you'll have to show you disability is so severe that it impedes your ability to be employed at all.

Determine the Income Threshold

The insurance company will also determine if you can make a minimum amount of income in the occupation you qualify for. This amount is typically set as a percentage of the money you were making before you were disabled. For instance, your policy may define gainful employment as a job that pays you a minimum of 60 percent of your previous income. So if your past job paid $100,000 per year, any position you qualify for would have to pay you a minimum of $60,000 to be considered gainful employment.

If your insurance provider finds you are able to get work in your field or a different industry, you may still be able to qualify for benefits if you can show the income you're likely to earn is less than the minimum threshold set by the company. This can be done in a variety of ways, including providing income comparison information from reliable resources such as the Bureau of Labor Statistics or a qualified vocational expert.

You Must Be Reasonably Suited for the Job

A third thing the insurance company will look at is whether you are reasonably suited to be employed. This includes the usual traits such as skills, experience, education, and physical and mental abilities. However, it also includes environmental issues that can affect your ability to be employed such as:

  • The availability of jobs in your area or within a reasonable commuting distance from where you live
  • Whether the employment is compatible with your medical needs (e.g. the position negatively impacts your physical rehabilitation)
  • Whether the company can adequately accommodate your disability (e.g. build ramps for your wheelchair)
  • Whether your doctor has approved you to perform the duties required by the position (e.g. stand for several hours a day)

While you may be able to work in a job that pays the minimum income required, you can still be approved for disability benefits if you can show you are not reasonably suited to be employed. You'll need to provide as much supporting evidence as possible. For instance, submit a Google map showing the jobs you qualify for are an unreasonable amount of distance from your home.

For more information about this and other issues that may come up with your claim for long-term disability benefits, contact a disability claims attorney.