The Hidden Role of Job Skills in Winning (or Losing) Your ERISA Disability Claim

Welcome to Season 5, Episode 35 of Winning Isn't Easy. In this episode, we'll dive into the complicated topic of "The Hidden Role of Job Skills in Winning (or Losing) Your ERISA Disability Claim."

Most people think that winning a Long-Term Disability claim is all about proving you’re sick or injured, with medical records, doctor’s notes, or diagnostic tests. But in ERISA claims, that’s only half the story. What often makes or breaks your case isn’t just your health - it’s your job skills. Insurance companies know that every job leaves you with transferable abilities: skills, knowledge, and experience that could, in theory, be used in another line of work. And they use that to their advantage. By arguing that you can apply your past skills to a new occupation, carriers can deny or terminate benefits even when you clearly can’t return to your old job. In this episode of Winning Isn’t Easy, disability law expert Nancy L. Cavey explains how your work history and skill classification can shape the outcome of your claim. You’ll learn what “own occupation” really means, how insurers decide whether your work is skilled, semi-skilled, or unskilled, and how those labels can be twisted to fit their narrative. Nancy also discusses how vocational experts and work history forms are used, and sometimes misused, during the claims process, along with practical strategies to document your true job duties and protect your benefits. If your disability carrier says you can “do other work,” this episode shows you how to fight back with facts, clarity, and confidence. In disability law, understanding your skills isn’t just helpful - it’s essential. Winning Isn’t Easy, but with the right approach, you can make your story and your skills work for you.

In this episode, we'll cover the following topics:

One - The Own and Any Occupation Stages and Why Skills Matter

Two - How Carriers Classify Job Skills

Three - Work History, Vocational Experts, and Fighting Back

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Navigating Your Social Security Disability Claim. Give it a listen: https://wiessdpodcast.buzzsprout.com/


Resources Mentioned in This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://mailchi.mp/caveylaw/ltd-robbed-of-your-piece-of-mind

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://mailchi.mp/caveylaw/professionals-guide-to-ltd-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Long-Term Disability or ERISA claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.

Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals. 

Transcript

Nancy Cavey [00:00:00]:
 Foreign hey, I'm Nancy Cavey, national ERISA and individual disability attorney. Welcome to Winning Isn't Easy. Before we get started, I've got to give you a legal disclaimer. This podcast is not legal advice. The Florida Bar association says I have to tell you this. Now that I've said it, nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games that disability carriers and plans play, and what you need to know to get the disability benefits you deserve. So off we go. Today I'm going to be talking about a topic that isn't just important, it's central, it's crucial to the success of your ERISA disability claim.
 
 Nancy Cavey [00:00:50]:
 It's something called the job skills. Now, when most people think about, you know, proving up a disability claim, they think about medical records, doctor's notes, MRIs, diagnostic studies to prove an objective basis of the diagnosis. But ultimately your physician is going to be asked to give their opinion about your functional, physical, cognitive and or psychiatric restrictions and limitations. The reason ultimately that's important is that the the disability plan or policy that you have ensures your occupation and every occupation has certain skills, job skills that are essential to performing that occupation. What many disability applicants don't realize is that their work history, and more specifically the skills they've learned over their course of their employment, can determine whether the claim succeeds or fails, particularly at any occupation stage. Now, disability insurance carriers or plans know this. They know that every occupation teaches you things you know, gives you knowledge, gives you skills or expertise that in theory can be carried over into other occupations. And they can use this fact to their advantage.
 
 Nancy Cavey [00:02:06]:
 They may argue at the any occupation stage that the skills that you've learned in your past occupation will transfer into a new occupation. And they'll say that you can still work even if you can't work in your old occupation. And that of course, doesn't necessarily matter at the any occupation stage. But they'll say, hey, you could do another occupation because of the skills that you have that transfer notwithstanding your restrictions and limitations. Many claims are denied not because the person isn't disabled, but because the disability insurance carrier plan has either purposely or negligently misunderstood, misclassified, or misapplied the definition of any occupation and have misunderstood, misclassified, misapplied a transferable skills analysis that their liar for hire in house vocational provider has performed. So I'm going to take this apart in a couple of different ways. First, I'm going to explain what the own occupation stage of a claim is and why your past skills become a big deal. We're going to dig into how carriers classify work as unskilled, semi skilled or skilled, and then how that classification can be twisted against you.
 
 Nancy Cavey [00:03:22]:
 Then finally, we're going to get practical about the work history forms, vocational experts and strategies that you can use to fight back if your claim is threatened. And by the end, the goal here is that you understand why being precise about your occupational history and your skills matter as much as your medical records, and how that right approach can protect your benefits. So let's get going. I'm going to talk about three things today. Number one the own and any occupation stages and why skills matter 2 how carriers classify job skills and 3 work history vocational experts and how you can fight back. Before we get into this, let's take a quick break.
 
 Speaker B [00:04:04]:
 Have you been robbed of your peace of mind by your disability insurance carrier? You owe it to yourself to get a copy of Robbed of your peace of Mind, which provides you with everything you need to know about the long term disability claims process. Request your free copy of the book@kvlaw.com today.
 
 Nancy Cavey [00:04:38]:
 Welcome back to Winning Isn't Easy, the Own and Any occupation stages of your disability insurance policy or plan and why Skills Matter. Now getting your own ERISA disability benefits isn't easy. At the own occupation stage of your claim, many policies or plans are going to be looking first at your own occupation and then ultimately at your ability to do any occupation in the any occupation stage. The test is different, if you will, than the own occupation stage. So let's break this down. At the own occupation stage, the test is generally whether you can perform the material and substantial duties of the occupation you had when you became disabled. Now that's not the only definition of disabled or occupation. So you need to get your disability policy or plan out and read it cover to cover so you understand what what the applicable definition is of your own occupation.
 
 Nancy Cavey [00:05:35]:
 That could be the occupation as you perform it for your employer in the local economy, in the national economy pursuant to the Dictionary of Occupational Titles. You also need to understand what it is the standard is in terms of your ability to do that occupation. Is it an inability to do the material and substantial duties of the occupation? The inability to do all of the material and substantial duties in occupation? Inability to do the important duties of the occupation? There are all sorts of variations, but you need to understand that because obviously things are going to be important as that definition of disability changes. So instead of asking can you do your old occupation? The policy is going to shift to can you do any occupation that you're reasonably qualified for based on your education, your past work, your occupational skills, and your medical restrictions and limitations? Now, this is where the carriers really start dissecting your past. They're going to examine every part of your employment history to determine whether you have the skills that could be used elsewhere. It's called transferable skills. When you apply for your disability benefits, one of the forms you're going to be asked to fill out is a job or occupation history form that will ask you questions about your occupational history, the skills that you've learned, the equipment that you've learned, classes that you may have taken. They're going to update that when the definition of disability changes from your own occupation to any occupation.
 
 Nancy Cavey [00:07:01]:
 So if you see that form come along in your mail, you know that they're starting to do analysis of an any occupation stage. So let me give you an example here. Let's say you're a warehouse manager, and at first glance, you might think that this job is purely physical. Stocking, lifting, bending, running inventory, maybe even operating forklifts. But when carriers look deeper, they just don't see the labor. They see supervision. They see scheduling, budgeting, training, problem solving, and leadership. They see skills that they are going to argue are transferable to other occupations, notwithstanding any problems that you have physical limitations that you have.
 
 Nancy Cavey [00:07:42]:
 Let's say you've injured your back. You can't stand for long periods, you can't lift heavy items, and you can't sit for too long because it's painful. You're positive that you can't go back to the warehouse, but the carrier says, oh, but wait a second. You know, this person can't run a forklift anymore, but they can still sit at a desk. They can manage employees, they can analyze spreadsheets, they can do orders. You can still be a manager. Any occupation stage. They may say, well, you may not be a manager in a warehouse, but you could be a manager in a bank or a call center, or even a mortgage office, even though you don't have that experience.
 
 Nancy Cavey [00:08:18]:
 So here's the trap. Carriers focus less on what you can't do physically and more on what you've proven that you can do intellectually or managerially. So unless your medical records or restrictions document the way that any of your restrictions, limitations impact your ability to do those kinds of things, the carriers are going to argue that you're still employable because you have transferable skills. So that's why understanding how your skills are perceived and how they might be Twisted is is really essential. The own and any occupation stages just aren't about a medical condition. It's about the work history and transferable skills that intersect with your medical condition. Exactly. At the end of the day, what skills have you learned by virtue of your past work or experience that are not transferable to any other occupations? That's the key to winning your case.
 
 Nancy Cavey [00:09:12]:
 Got it. Let's take a break. Welcome back to Winning isn't How Disability Insurance Carriers and Plans Classify Job Skills. Now, when disability carriers or plans analyze your claim, they aren't going to rely just on that job title or even your description of what it is you did. They're going to classify your work according to categories created by the Department of Labor Dictionary of Occupational Titles, known as the dot. These categories fall into three very broad levels. Unskilled, semi skilled, and skilled work. Unskilled work requires little or no training, and these jobs are jobs that you can learn in 30 days or less by watching or practicing.
 
 Nancy Cavey [00:10:04]:
 Cleaning, sorting, basic assembly, and simple data entry will fall into this category. The second is semi skilled work, and it involves some training and decision making, but it doesn't demand specialized education. Examples can include machine operators, certain clerical positions, or even sales associates there. Lastly is skilled work, and that requires longer training, specialized knowledge, and often a higher level of education or experience. Management, technical and professional roles normally fall here. And with each of these three categories there are variations. We generally call this in the Social Security world, specific vocational preparation, svp. So there are different prep levels in each one of these classifications of work and their vocational carrier.
 
 Nancy Cavey [00:10:50]:
 Evaluators are going to look at your past occupations and look at what you've learned in terms of your education, what classes you may have taken as part of your occupation, what skills you've learned. And they're going to classify the work that you did in the past. They're going to assign it an svp. And the higher the svp, the more likely they're going to be transferable skills, certainly from a cognitive standpoint than from a physical standpoint. So let me give you an example here. Let's say your work has always been unskilled. You are a janitor. You work in a factory.
 
 Nancy Cavey [00:11:27]:
 Carriers are going to have a hard time claiming that you have skills that can transfer to another job, either physically, psychiatrically, or cognitively. But if you've been in a skilled role, like management, accounting, engineering, law, or medicine, they're going to argue that your knowledge base can easily be used in a new industry or in a new setting. That's transferable skills. And they're going to try to transfer those skills to an occupation that has a specific vocational prep that's consistent with whatever your restrictions and limitations are. They're going to sometimes try to put a round peg in a square hole. It sounds reasonable on paper, but in practice it's often misleading. Carriers will frequently exaggerate the transferability of skills without accounting for real world functional limitations that your disability creates. Let's go back to my warehouse manager example.
 
 Nancy Cavey [00:12:17]:
 On paper, management looks like a skill that easily transfers to a desk job. But what if you can't sit for more than 20 minutes without pain and you have to get up and move around and change positions? So you sit, you walk, you might even lie down. How about your medication causing you to be drowsy? Or how about your neuropathy from your back pain that impacts your ability to actually sit there and maybe use a foot controls or for example, to operate equipment. Or let's say you have a neuropathy in your upper extremities that prevents you from typing or using your hands. In that case, your so called transferable skills don't actually translate into viable employment. That's why I think it's really important that you are explaining to your physician your symptoms and your functionality. What are your symptoms? How do they impact your ability to function? And because ultimately the question is how do those symptoms and functionality impact the question of transferable skills? And I will tell you that the problem I see is the carriers and plans rarely account for these details unless you force them to. They'll run a vocational analysis using a computer program.
 
 Nancy Cavey [00:13:27]:
 They'll plug your work history into a program like Skilltran, and that will spit out a list of supposed alternative jobs or occupations that, you know, kind of look feasible on paper, but may be impossible for you in reality. That's why classification is so dangerous. If your password is misclassified as more skilled than it really is, your claim becomes harder to win because we have to convince them that that misclassification was material and that you only have certain types of transferable skills. If your restrictions and limitations are understated. Carriers are going to say that your skills can carry into occupations that you really can't perform. So we've got two things going on. We've got misclassifying the past work, the specific vocational preparation. We have problem with what the transferable skills might be.
 
 Nancy Cavey [00:14:21]:
 And then we also have a problem with them misconstruing, misunderstanding, misapplying your restrictions and limitations, and then saying, hey, even with these restrictions and limitations your skills can carry into other occupations that in reality you can't perform. So you can see that those three things are really crucial in the analysis of a claim, particularly at the any occupation stage. Understanding this and anticipating how your work is going to be classified is, in my view, key to preventing your skills from being used against you when we get to the own occupation stage. Got it. Let's take a break.
 
 Speaker B [00:14:59]:
 Are you a professional with questions about your individual disability policy? You need the Disability Insurance Claim Survival Guide for Professionals. This book gives you a comprehensive understanding of your disability policy with tips and to dos that will assist you in submitting a winning disability application. This is one you don't want to miss. For the next 24 hours, we are giving away free copies of the Disability Insurance Claim Survival Guide for Professionals. Order yours today@disabilityclaimsforprofessionals.com.
 
 Nancy Cavey [00:15:48]:
 Welcome back to Winning Isn't Easy. Your work history and vocational experts and fighting back in your ERISA disability claim We've been talking about the games that are played at the own occupation stage when the definition of your disability changes from an inability to do your own occupation to an inability to do any occupation. What's important in this analysis is that when you apply for your disability benefits, you're asked to complete a work history form and on the surface it looks straightforward. You list your jobs, you describe your duties, you you explain what tools or equipment that you've used. But in my view, this form is one of the most critical documents in your claim. Why that is going to shape the carrier or plan's entire analysis of your occupational skills. Here's one of the mistakes that I see all the time. People will exaggerate their occupational duties to make their past job sound more important, or they may gloss over the details thinking that titles alone tell the story.
 
 Nancy Cavey [00:16:50]:
 For example, somebody may write the word manager and leave it out. The rest of the important stuff did you supervise five people? 50 people? Did you handle payroll? Did you assign shifts? Did you do any scheduling? Did you do any training? Did you do ordering? Did you do presentations? Did you do safety meetings? Just saying you're a manager doesn't tell us what your occupational duties are, which can also prevent us from understanding what occupational skills you have. I will tell you the danger is that the carrier or plans vocational expert the VE is going to fill in those blanks and guess what? Not in your favor. Because once they step in, things can get messy. The vocational evaluator, who's generally an in house employee of the disability insurance company or the plan is going to review that work history form. They're going to use a tool called the Dictionary of Occupational Titles, and they're going to look at their work orchestry form and say, well, you know, I think that this is an occupation that fits under this particular dot code. And they make mistakes in this analysis trying to plug it into a dot that will allow, as they well know, for you to be ostensibly able to do another occupation because there are allegedly skills that you've learned. So they're going to look at your work history form.
 
 Nancy Cavey [00:18:17]:
 They're going to say, you know, I think this may fit dot code, blah blah, blah, blah, blah, blah blah. And based on that dot code, they're going to run via computer a transferable skills analysis. They'll use programs like skilltran. They're going to generate a list of alternative occupations that you could allegedly do in the national economy. And I will tell you, I see all sorts of crazy analysis done by disability carrier or plan VE's. They'll come up with skills that you don't have. They'll come up with occupations that really don't use the skills. They come up with occupations that don't meet your functional, physical, cognitive or psychiatric restrictions limitations.
 
 Nancy Cavey [00:19:02]:
 And then worse yet, they'll come up with numbers of jobs that don't aren't realistic either. But that's a different topic for a different day. So the problem here is they start out by misclassifying your previous jobs and they may decide, for example, that your clerical role was a skilled administrative manager position. Or they might misinterpret part of your job, like the occasional computer use as a core skill that you could transfer into another industry. This is where you really need to have the assistance of an experienced ERISA disability attorney, preferably one who has Social Security experience, because this is the game that is played in every Social Security disability claim at steps four and five of the five step sequential evaluation used in a Social Security case. Practically every Social Security case we try, we're dealing with these very issues. What was their past occupation? What's the dot code? What's the preparation level based on these sets of restrictions and limitations? Are there transferable skills? So the goal here actually from the very beginning, but certainly in an appeal, is to challenge the misclassification of the prior occupation. We want to make sure that your work history is accurate and detailed.
 
 Nancy Cavey [00:20:19]:
 We want to make sure that your restrictions and limitations are clear. And that may be you getting a functional capacity evaluation, because we want to understand that your past occupation had certain skills, but that you have certain restrictions and limitations. And as a result of those restrictions and limitations, you don't have these skills X, Y and Z that might transfer to other occupations. And when necessary, practically in every one of these cases where we're fighting about vocational issues, we hire a vocational expert to counter the carrier's liar for hire analysis. From the misclassification to the transferable skills analysis to all the other mistakes that the VE for the disability carrier plan makes. Now remember, if your claim is denied or terminated, you're only going to have 180 days in which to appeal. And that appeal is not paperwork. It's your trial.
 
 Nancy Cavey [00:21:13]:
 It's your one opportunity to put evidence into the record to show what your past occupation was, what the skills were, how your restrictions limitations impact that transferable skills analysis, and to destroy every job that the disability carriers VE said existed. In view of the alleged restrictions and limitations, you want to dismantle the entire fault analysis. So please don't let vague work history forms, misclassified skills, or botched transferable skills analysis sink your case. Carriers are counting on you not to understand this issue, not do an appeal, or not do an appeal with a competent or qualified attorney is something that you need to take very seriously. Because ultimately, if you are in litigation, the federal judge is only going to be able to look at what was in the disability carrier plans file at the time of the last claims denial. There is no trial, there's no time to add new evidence. So you need to understand that making a mistake and not hiring an experienced ERISA disability attorney can be crucially fatal, if you will, to your claim. So don't make a mistake like that.
 
 Nancy Cavey [00:22:26]:
 Thanks for tuning in to this week's episode of Winning Isn't Easy. If you found this episode helpful, please take a moment to like our episode, leave a review, share it with your family and friends, and subscribe to this podcast. I'd love to hear from you about the podcast because at the beginning of each episode description you can find a little link where you can send me questions or comments. I read them and I want to feature you in a future episode with your question. Got it. So join us next week for another insightful episode of Winning Isn't Easy. Thanks for listening.