People often do not realize that in the legal world, “disability" is a term of art, with a very specific meaning. In fact, it has several different specific meanings, depending on the context. “Disabled" has one meaning for the purposes of the Americans with Disabilities Act, another for the purposes of worker’s compensation, still another when talking about things like exemptions from jury duty or from testifying in court, and there are probably a dozen others. Not surprisingly, “disabled" has a very specific meaning in the context of a Social Security disability or Long Term Disability benefits claim. In most circumstances, though, in order to be considered “disabled," and entitled to disability benefits, a person need not be comatose, or bed-ridden, or entirely unable to care for themselves. A disabled person, for the purposes of disability benefits, may be able to live a relatively normal life – he is just unable to work – sometimes not at all, sometimes just at his or her last job.
In some cases, the question of just “how disabled" someone needs to be gets even narrower. What about part time work? Some jobs are available part time, others aren’t. Even if a disabled person could, theoretically, do his old job on a part time basis, could he keep it up for the long term? Could he live on what he earns part time? How many hours per week do you need to be able to do before you are “not disabled?" These are often questions that come up in disability benefits cases, especially for people who are right on the cusp – they aren’t able to work enough to support themselves, but they aren’t completely incapable of work, either.
The Social Security Administration has its own definition of disability and its own set of regulations detailing the disability process, which I won’t discuss here. But many people have purchased short-term and long-term disability insurance, either through an employer or through a private insurance broker, in an attempt to protect their income from disability even more. That is what insurance is designed to do, after all. Insurance protects something. If the insured thing ever fails, the insurance pays you money. If you get in a car crash, auto insurance pays. If your house burns down or is damaged in a storm, homeowner’s insurance pays. If something happens to your body, medical insurance pays. And if something happens to your ability to earn a livelihood, and your working income disappears or significantly drops, then disability insurance should pay.
Most group disability insurance policies (the ones people typically sign up for at work) will pay 60% of a disabled person’s pre-disability income if they are unable to work. Most policies contain a definition of disability that states that, at some point during the claim (either in the beginning or after a few years of benefits) the claimant must be disabled from “any occupation." I.e., you must be “unable to perform any occupation" to receive your disability benefits. If that is the case, and the claimant is theoretically capable of some part-time work, then what happens? Should someone be denied all of their 60% LTD benefit because they could still theoretically earn 10% of their pre-disability income? No, of course not. That would be contrary to the purpose of the insurance plan, which was designed to protect 60% of the person’s income. It would be similar to your car insurance carrier refusing to pay for any repairs to your car after an accident if it is “still driveable."
The disability insurers themselves do not always agree with this. Many times, a person will be denied benefits in just the manner I described above – e.g., a former lawyer who suffers a traumatic brain injury is no longer able to work as a lawyer, but might be able to work as a parking lot attendant. Since he can still do something, the insurer might say that he is not disabled from “any occupation," and might refuse to pay anything. Similarly, consider the example of an airplane mechanic who can still do his job, but can only do it for a few hours per week. He might also be denied by his disability insurer because he can still do something. Both denials would be wrong, because they are contrary to the purpose behind the insurance plan – protecting a certain amount of income.
When faced with these types of cases, the courts have intuited that “any occupation" is not a literal term. For example, in one court case, the disability plan language stated that a person is disabled when she “is prevented from engaging in any occupation or employment for remuneration or profit." Analyzing this language, the court said that the “any occupation" standard should not be interpreted in an excessively literal manner, but must mean an occupation that allows the claimant to earn a reasonable income:
Analogous insurance cases consistently agree that the term “total disability" does not mean absolute helplessness on the part of the insured. The insured can recover benefits if he is unable to perform all the substantial and material acts necessary to the prosecution of some gainful business or occupation. Gainful has been defined by these courts as profitable, advantageous or lucrative. Therefore, the remuneration must be something reasonably substantial rather than a mere nominal profit.
Helms v. Monsanto Co., Inc., 728 F.2d 1416, 1420 (11th Cir. 1984). This holding has been expressly adopted by other courts, as well. In another case, the disability plan defined total disability as the inability “to be gainfully employed anywhere." Following Helms, the court held this required a “reasonably substantial income":
We now further adopt the holding in Helms that gainful employment is that employment from which a claimant may earn a reasonably substantial income rising to the dignity of an income or livelihood, even though the income is not as much as he earned before the disability.
Tracyv. Pharmacia & Upjohn Absence Payment Plan, 195 Fed. App’x 511, 519 (6th Cir. 2006). See also Demirovic v. Building Service 32 B J Pension Fund, 467 F.3d 208, 215 (2nd Cir. 2006) (“any gainful employment" means employment allowing a claimant to earn a reasonably substantial income from it, rising to the dignity of an income or livelihood, though not necessarily as much as she earned before the disability"); Torix v. Ball Corp., 862 F.2d 1428 (10th Cir. 1988) (similar finding).
One court pointed out that a disability benefit plan should be construed "with a view toward effectuating its general purpose." Wulf v. Quantum Chemical Corp., 26 F.3d 1368, 1374 (6th Cir. 1994). As an example of how this should work, assume a plan is designed to replace 60% of a worker’s pre-disability income if she is no longer able to work. She files a claim under that plan, and her doctor says that she might be able to work up to two hours per day at her old job, but could not sustain full-time work. Two hours per day is one quarter of a full eight hour work day, so the worker might be able to earn up to 25% of her pre-disability income, assuming her doctor is correct about her abilities, and assuming she could actually find a job that would allow her to work that schedule for the same hourly wage she used to earn. The LTD policy requires her to be disabled from “any occupation," and the terms of the policy do not delve deeper into nuances of partial disability and part-time work. Nevertheless, it would be wrong for the insurer to deny her the 60% disability benefit under the policy just because she has a theoretical capability to earn 25% of her pre-disability income. That would make no sense, and would defeat the purpose of the insurance.
“Any occupation," in the context of a disability benefits plan, is not literal, but implies an occupation providing a reasonably substantial income under the circumstances. An employee benefit plans,in particular, should be construed with a view toward effectuating its general purpose. So when a long-term disability insurance plan is designed to protect, for example, 60% of a worker’s pre-disability income, it is contrary to the purpose of the plan to deny benefits because the worker could earn 10%, 20%, or even 50% of her pre-disability income. The insured interest – the thing the insurance was designed to protect – was 60% of the worker’s income. If she is unable to earn that much, then an ability to engage in part-time work should be insufficient to render her “not disabled" under the LTD plan. Just “how disabled" does she need to be? Look to the terms of the plan to find out.
Grand Theft
I am a first time offender being charged with 2 counts of 3rd degree grand theft. more than $300 less than $20,000. What is the punishment ill recieve??
Child Support
My daugher is 18 and will not finish high school this year due to pregnancy with a 2nd child, but plans to finish school next year. Is she legally emancipated because she has 1 child and 1 on the way or do I have to continue to pay child child support? I have encouraged her to get a GED but her mother doesn't want that to happen. It is their decision and not mine to do school another year when a GED would suffice and my daughter could enter the work force. She is already receiving food stamps which may have an impact on the support as well.
Hello,
I had two cousins named suresh and ramesh. My cousin named Ramesh purchased a townname on my ssn in 2004 and I have signed when the purchase was done and later also when refinancing was done for the mortgage.The townhome was a joint property of my cousin Ramesh and me and he had promised me verbally that he would make payments on time when he did until march 2009.
To explain you in detail, this is a favor that I was trying to do for both of my cousins ramesh and suresh since they wanted to purchase a townhome for investment purpose and I had nothing to do with the property other than signing the documents and having it on my name. They couldn't have it on their names completely since they already owned homes. I have completed my master's in US on student visa in 2003 may and started working in June 2004. My cousin purchased this home after june 2004.
I had travelled to India in feb 2009. In feb before leaving to India, my cousin had mentioned that he wanted to sell the property since he doesn't have a job at that point of time and cannot afford to make payments and had mentioned that he would talk to a loan official regarding the mortgage and made me sign power of attorney that said that I am willing to give the power of attorney to Suresh to sell off my property. He also took a copy of two recent bank statements and a copy of my w2 before I was leaving to India.
I was in good terms with my cousin until 2009 Feb and travelled to India and there were family disputes where I was not involved at all. My cousin had assumed that I was the one for all the family disputes and inorder to take revenge on me and my family back home, he stopped making loan payments from april 2009 even though he got a job and started working. My stay in India was from feb 2009 to Sep 2009.
My cousin sent me an e-mail in Aug explaining that he wanted to sell the property and he purchased the property for 215K and the homes are selling now for 50k to 60k. He could not sell the property in Feb. So, he need my recent bank statements and w2 again to consider selling the property. He also mentioned that if I do not give him the documents he needed, he will not be able to sell the property and my credit history would be ruined. My family and his family had a big time conflict. Even then, I sent him the documents he needed again.
I came to US in the end of Sep 2009. I found out in Jan 2010 that I had "Derogatory" on my credit report for the town home that Ramesh had purchased.I also see on my credit report that a late payment from May 2009 thru Sep 2009 had been posted. I called the mortgage company and was asking them what had happened.The mortgage company had told me a shoking news. He told me that first of all the town home is only on my name or ssn and there are no others on this
property. Also, he said that they had sent tons of letters to the townhome address and no one responded. So, they had to seal the property and sell it away with the help of a broker company.
Another surprise is that I see online that the property had been sold that by a realtor company owned by Suresh. Mr.Suresh is a realtor too apart from working in IT. So, I am not quite so sure what has happened because I do not have much knowledge on Home Mortgage/purchase/selling.
On the sellers website, it displays Listing Agent: "Suresh" (See Actives & UC / Solds: Lister / Buyer / Both) and the listing broker is Michael Conway Realty LLC. Below is the link:-
http://franklymls.com/PW6969874
My cousin used to have Michael Conway Realty LLC in his signature section when he was sending e-mails to me. So, I am really not sure if he works for this company or if he owns it.
How can I fight to remove the derogatory marked on my credit report for this town home mortgage by my cousins suresh and ramesh? The only proof I have is I never made any payments for the townhome from my bank account for all these years and the e-mail written by Suresh would be a 2nd proof in Aug 2009 that he wanted to sell the home which he never did.
Thanks for all of your help
Grandparents for custody
My stepsister left her two kids with my parents to go and marry some guy in another state whom she met online. Can my parents have custody, is this enough basis for them to file for custody? The father who lives in another state agrees to giving them custody while he tries to do a job transfer from the US Post office.