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The Different Definitions of Disability
under Federal Law
by Gregory G. Paul,
Attorney at Law, Morgan & Paul, PLLC
The Equal Employment Opportunity
Commission is a federal agency charged with the enforcement of our federal
employment laws that protect against discrimination based upon age, disability,
race, gender and retaliation. On March 25, 2011, the Equal Employment
Opportunity Commission issued its final regulations to the Americans With
Disabilities Act Amendments Act (ADAAA). Under the Americans With Disabilities
Act, an individual will only receive protections of this law, such as
reasonable accommodations and the prohibition of disability discrimination, if
he or she has a “disability” as defined by the statute and regulations. An individual under the Americans With
Disabilities Act has a “disability” if he or she is substantially limited in
one or more major life activities. Prior
to these amendments, individuals with diabetes were often not covered by the
Americans With Disabilities Act. As a
result of many court decisions denying rights under the Americans With
Disabilities Act, the American Diabetes Association along with other
organizations lobbied Congress for important changes to this law. Under the
amended law, the Americans With Disabilities Act almost always covers
individuals with diabetes based upon limitations in endocrine functioning. The definition of disability under the
Americans With Disabilities Act is now significantly broader and offers
increased protections against employment discrimination for individuals with
diabetes.
However, the definitions of disability
can vary based upon different laws. For
instance, many short-term disability and long-term disability plans divide the
definition of disability into the inability to perform one’s “own occupation” and
the inability to perform “any occupation”.
Many employer sponsored disability plans provide 60% of monthly income
as a disability benefit for a period of 24 months based upon a definition of “total
disability”, the inability of the employee to perform the substantial and
material duties of his or her “own occupation”.
This first part of this definition is significantly easier to prove than
the establishment of the employee’s inability to perform the substantial and
material duties of “any occupation”.
After this initial 24 month period, an individual may continue to
receive disability benefits through age 65 or normal retirement age if he or
she can establish through medical and vocational evidence the inability to
perform “any occupation”. While this
area of employer sponsored disability benefits is governed by a federal law
called the Employee Retirement Income Security Act (“ERISA”), the definitions
of disability vary depending on each individual policy. As a result, it is necessary to review the
summary plan description (SPD) or the actual policy that is usually
administered through an insurance company such as UNUM, Liberty Mutual, Cigna,
Hartford- to name only a few. ERISA
establishes certain procedural protections for individual’s applying for
disability benefits such as the right to receive the claims file within 30 days
and without charge. However, the initial denial of disability benefits must be
appealed through a written document to the insurance company within 180 days.
If the denial is not properly appealed, the individual may be permanently
denied additional disability benefits without the right to file a complaint in
federal court.
Similar to the “any occupation”
definition of disability under an employer sponsored long-term disability plan,
the Social Security Administration defines disability based upon the inability
to perform substantial gainful activity (SGA).
The Social Security Administration defines substantial gainful activity
based upon a five-step evaluation process. To be eligible for Social Security
disability benefits, an individual applying for benefits must 1) not earn more
than $1,000 a month, 2) have a “severe” impairment that interferes with basic
work-related activities, 3) establish one of the conditions included in the
Listing of Impairments published by the SSA, 4) if an individual does not meet
one of the Listings, then SSA must decide if an individual is capable of
performing a job performed in the past 15 years; and 5) decide whether an
individual can perform any work based upon the individual’s age, education and
past work experience. It is important to note that SSA may award benefits if
the individual can perform some work, but only on a part-time basis.
Additionally, if the individual is age 55 or older, the SSA may award benefits if
the individual is only capable of performing sedentary or light work.
In summary, the definition of
disability varies upon the particular federal statute and regulations. Under the employment discrimination laws,
disability is defined differently than employee benefit laws such as ERISA and
the Social Security Act. For more
information, please view www.eeoc.gov, www.ssa.gov, www.diabetes.org/attorneymaterials, or our website at www.morgan-paul.com. To speak with an attorney, please
call our office at 1-888-967-5674 or email me at gregpaul@morgan-paul.com.
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