Over the last few years, insurance companies have come up with a variety of loopholes to avoid paying policyholders long-term disability. Two of the most common reasons, are termed “own occupation” and “transferable skillset”. Own occupation, essentially allows the insurance company to deactivate your long-term disability compensation if after a two-year period they do a re-examination of the situation and they determine you can continue your own occupation. On the contrary, a transferable skillset, which is what we will discuss today, is a clause in which a person can be disqualified from their disability benefits if he or she has a skill set that can be used in a different department.
The transferable skillset clause, in particular, has become a point of contention for lawyers working with injured employees in blue-collar jobs. Comparable to the own occupation clause, the employees are cut off from their benefits, because of their skills. In other words, if you or a loved one has sustained a back injury, which does not allow you to lift things, you may be switched to a desk job.
In a desk job, you can transfer your skills of filling out forms for deliveries of shipping receiving, to filing documents, and making phone calls for deliveries. With this being the case, you will be paid the salary you had prior to your accident, and the insurance company will not have to compensate you any longer. In accident benefits claims, the clause that forces a victim back to work is called the sedentary work clause.
As the name transferable skillset suggests, you can transfer certain skills from the job where the accident took place, to a job that at the very least is easier for you to do. For example, when a computer is programmed it may require the person programming it, to lift a heavy CPU, before attaching it to a monitor. However, once your accident happened, you may only be able to do the programming part, but not the lifting. As this is the case, the insurance company may require, that you deal strictly with the programming aspect of your job, as you can still technically do that, without using the injured body parts. This then, allows the insurance company to either disqualify you from benefits completely or in some cases, limit the number of benefits you are receiving.
But, is it really fair to deny a person’s claim based entirely on their skillset? Depending on the severity of their injuries, an accident victim may have more damage, than what appears from a physical aspect. When an accident takes place, many people suffer emotional pain and suffering, which gives off a ‘shell shocked’ experience. As a result, the person may no longer be able to complete their job or a job with similar skills required of them, because they are traumatized from the accident. Some people are able to work for only a few hours a day because the physical demands are now too much. Meaning to say, it is unfair to deny them their claim, because they aren’t actually better.