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"Substantial and Material" Acts Under ERISA

LTD and ERISA Lawyers: Riverside, Orange & San Bernardino Counties

Your Job Description and the Policy

When applying for long-term disability (LTD) benefits, your job description will be of considerable importance, because you must show that you are unable to perform the “substantial and material” actsof your job or occupation. 

Policy Terminology - What Does “Substantial and Material” Mean?

Disability insurance policies use such terms as “substantial and material” to refer to the essential tasks, duties, acts, functions, and operations required to perform your job or occupation, that cannot be reasonably omitted or modified. Some policies provide that you are disabled, if you are unable to perform, with reasonable continuity, at least one of those “substantial and material” acts. Other policies require that you be unable to perform all the “substantial and material” acts. The latter, of course, is a stricter requirement and may be more difficult to prove.

Many courts hold that you are considered disabled if you cannot perform even one of the substantial and material acts that your job requires. We think that this is the better view. However, not all courts agree, and in reviewing your policy, it is important to carefully look at the language of your policy to see if it requires you to be unable to perform all the substantial and material acts.

Is Your “Occupation” the Same as Your “Job”?

Your ‘job” and your “occupation” are not necessarily the same. Some disability policies make a distinction between your job and you--r occupation. In general, your “occupation” refers to an employment, business, trade, or profession in the community, which may not be the specific job you perform for your employer.
In evaluating your disability claim, many policies will first look at the specific duties that your job requires you to perform. If you are unable to perform one or more of those job duties, the policy then considers whether those duties are customarily required of other employees engaged in your occupation in the community. If the duties your job requires are different than are required of other employees in your occupation, then those job duties may not be considered in determining what substantial and material acts are necessary to pursue your usual occupation. 
Courts may differ as to their interpretation of “job” versus “occupation,” but the better view, when there is a discrepancy, is to consider what job is performed by the employee for the employer, rather than what duties are customarily required by a person's occupation in the general community. 

What does your policy say? Pay attention to whether your policy (1) makes a distinction between your “job” and your “occupation,” and (2) whether, to be considered disabled, it requires you to be unable to perform oneor allthe substantial and material tasks of your job or occupation.

How We Can Help

Our medical experts will review your case and get to know the variations of your condition. This translates into helping the legal experts know how to argue your case and fight for the benefits you deserve.