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Caution! Training, Education and Experience

Training, Education and Experience – What It Really Means in Disability Insurance

I am often asked by clients and advisors, “What does training, education and experience really mean in a disability insurance policy’s definition of disability?”

While there is no single definitive answer as many agents and brokers suggest, there are standard practices in place with all disability insurers to determine a claimant’s employability. Hartford Life, a leading group disability insurer, has a very specific process used to determine one’s employability under the terms of their group disability insurance contracts.

First, the claim is referred to a vocational rehab counselor who will perform an employability analysis on the claimant. This involves assessing the claimant’s education, work history, and training. Then a separate rehabilitation case manager will evaluate the claimant’s transferable skills to better determine a degree of employability in unskilled and/or light and sedentary positions. This is done through a transferable skills analysis.

The transferable skills analysis is done using job match software which contains information from the US Department of Labor’s Dictionary of Occupational Titles (DOT). The DOT classifies and describes occupations in the United States and their median wages. The transferable skills analysis includes a process known as a “job-person match.” This is where the insurance company evaluates a person’s past working habits and traits to find jobs with similar work habits and traits. This process is relied upon more when a person’s physical or mental capabilities have changed from those previously required in their work history.

The insurance company reviews the DOT “sedentary and light occupation” list if there are no transferable skills found in the analysis. This list includes occupations such as tube operator, scoreboard operator, nut sorter, dowel inspector and lens inserter to name a few.

Ultimately, the insurance company has a very specific process that seeks occupations one can perform with substantial physical and/or mental disabilities. The insurance company can deny claim payments if they find the insured has the ability to perform an occupation through the insurer’s employability test. The policy does not require that the insured acutely perform the job for a wage, rather that they have the ability to perform the job. The end result is a denied claim leading to costly and often unprofitable litigation.

The insurance company’s ability to deny a claim when one has the ability to perform “light and/or sedentary positions” under this definition of disability is the primary reason I endorse own occupation policies.