What is “Gainful Employment” for Long Term Disability?

When trying to better understand long-term disability, or when applying for disability benefits for your long-term disability, one term that you may come across is “gainful employment.” In short, this term refers to an LTD applicant’s ability to work, and if an individual is unable to engage in a substantial gainful activity (SGA), then he/she may be eligible to receive long-term disability benefits for his/her disability.

What Is "Gainful Employment" for Long Term Disability? - Herren Law

More specifically, if you are unable to hold any job where you would make 60-80% of your pre-disability earnings, then your long-term disability provider should pay benefits. Whether you are applying for LTD benefits, or the gainful employment aspect of your application is giving you troubles, then call Houston LTD attorney William Herren today. With decades of experience helping individuals like you, we fully understand the legal processes, what insurance companies are looking for, and how you can optimize your application.

We work on a contingency basis, and so you won’t pay a thing unless we win your case. For a free consultation with Houston attorney Bill Herren, call Herren Law today at (800) 529-7707.

What is a Gainful Occupation?

LTD policies often define “disability” in one of two ways, including:

  • Own Occupation: Your disability prevents you from the duties of your own occupation.
  • Any Occupation: Your disability prevents you from working in any gainful occupation for which you are reasonably suited, considering your education, training, and experience.

If you are able to work in any gainful employment, there is a higher possibility that your insurance company will deny your benefits. Furthermore, many LTD policies shift from “own occupation” to “any occupation” after a period of time (usually, it’s 24 months). This allows disabled individuals to find work outside of their own occupation.

Most LTD policies define “gainful employment,” however, as a job that is able to provide you with at least 60% of your pre-disability wages. Keep in mind that this 60% number is not universal, and so it’s important to refer to your specific LTD policy.

How Do You Know If You’re Reasonably Suited to Work?

In addition to understanding “gainful employment,” you also need to understand whether or not an LTD policy considers you as “reasonably suited” to work in your own occupation or any occupation. As you can imagine, the word “reasonably” is broad and open to interpretation, but in most cases, “reasonable suited” refers to an individual’s location, skills, education, and limitations.

An occupation would be considered “unreasonable” if some of the following factors apply:

  • There are few or no occupations available that are within a reasonable commute from your home.
  • The occupations available are beyond your skills or education level.
  • The occupation will interfere with your regular medical appointments, if applicable.
  • Your doctor has not provided a release that allows you to perform the tasks required of the occupation.

When submitting your application for LTD disability benefits, it’s very important to include as much evidence and information as you can. This information should include an opinion from your doctor that fully explains your working limitations, allowing the LTD provider to better assess your limitations as well as what types of jobs, if any, you’d be reasonably suitable to do.

Who Determines Whether You Work at Another Job?

Although you’ll be submitting your LTD benefits application to your insurance provider, your insurance provider will often work with vocational experts (VEs) to determine your employment possibilities and the compensation offered at various types of jobs available to you.

When making these assessments, the VE should be an expert in his/her field and rely on a number of sources, such as the Bureau of Labor Statistics, among others.

With the help of an LTD benefits attorney, your attorney should cross-examine the VE associated with your case, while making sure that the VE has all of the information he/she needs to know. A good attorney will also try to elicit a favorable response from the VE.

Call Houston LTD Attorney Bill Herren

Many insurance companies employ a long, complex rubric when determining whether an applicant has a disability that prevents him/her from working in his/her own occupation or any occupation. Showing your ability, or inability, for gainful employment will be an essential component for winning your LTD benefits case.

As such, you’ll need an experienced and capable attorney at the helm of your case, making sure that all of the necessary information is included in your application. For a free, no-obligation consultation with Houston attorney William Herren, call our law office today at (800) 529-7707.

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