Why ChatGPT Can’t Get Your ERISA Disability Claim Right (and What Actually Works)

Welcome to Season 6, Episode 17 of Winning Isn't Easy. In this episode, we'll dive into Why ChatGPT Can’t Get Your ERISA Disability Claim Right (and What Actually Works).

Let’s say you’re living with fibromyalgia, chronic fatigue syndrome, postural orthostatic tachycardia syndrome, multiple sclerosis, Parkinson’s disease, or recovering from a stroke, and the high-stakes, cognitively demanding job you once handled now feels out of reach. What should you do next? Stop working and file for ERISA disability benefits? Talk to an attorney? Or rely on generalized advice from online tools or AI? In this episode, we examine why one-size-fits-all answers (typically provided by AI) often miss the mark. Disability carriers don’t evaluate claims in the abstract, they scrutinize how your specific symptoms translate into functional limitations, especially when cognitive impairment is involved. Drawing on real cases, we break down how insurers assess these conditions, where claimants go wrong, and why incomplete or generic guidance can jeopardize otherwise valid claims. We also explore how an evidence-driven approach, backed by experienced legal guidance, can make the difference between approval and denial. If you’re navigating a complex disability claim tied to cognitive or neurological conditions, this episode offers a clearer view of what actually matters, and how to protect your benefits.

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

One - When ChatGPT Gives You the Wrong Answer

Two - How Disability Carriers Really Evaluate Cognitive Impairment Claims

Three - The “Own Occupation” Trap and How to Win Your Case

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.

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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. Let's say you have fibromyalgia, cfs, pots, ms, pd, or you've survived a stroke and you have continued to work, but you are working in a stressful, high functioning cognitive occupation that you just can't do anymore, you're finding it difficult to do and you're thinking about stop work and apply for your disability benefits. Should you consult with an experienced ERISA disability attorney? Or better yet, should you just ask ChatGPT what you should do? Hey, I'm Nancy Cavey, national ERISA and individual disability attorney, and I want to welcome you 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 say this and now that I've done that, nothing, nothing will ever prevent me from giving you an easy to understand overview of the disability insurance world, the games that disability carriers play, and what you need to know to get the disability benefits you deserve. So off we go. Now.
 
 Nancy Cavey [00:01:17]:
 Disabilities can affect both you physically and cognitively, and that's true of fibromyalgia, CFS, POTS, MS, Parkinson's, the aftermath of a stroke. These problems, these physical and cognitive problems can make returning to a high stress, high cognitive, demanding job nearly impossible. Now, many people are these days turning to online tools, device forms and even AI like ChatGPT to figure out their next steps. But when it comes to arrested disability claims, I think that general answers can be dangerously misleading. In this episode, I'm going to break down how disability carriers really evaluate cognitive impairment, why generic answers fail, and what you need to do to protect your benefits. So through real life examples in court cases, I'm going to try to show you why a personalized attorney guided approach is crucial. So I'm going to talk about three things. 1.
 
 Nancy Cavey [00:02:13]:
 When ChatGPT gives you the wrong answer. 2. When how disability carriers really evaluate cognitive impairment claims and the own occupation trap and how to win your case. Let's take a quick break before we get started.
 
 Speaker B [00:02:25]:
 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 [00:02:44]:
 SA. Welcome back to Winning isn't easy when ChatGPT gives you the wrong answer. So let me give you an example of a ChatGPT prompt and an answer our law firm was asked to address by a prospective client and the ChatGPT question was this. Give me a real honest, legally accurate answer about how disability carriers or plans view someone going out on LTD after age 60 based on ERISA standards, my carrier or plans past claim behavior, vocational rules and the specific facts of my medical and work situation with no sugar coating. Will my ERISA disability carrier or plan evaluate whether my conditions truly prevent me from doing my own occupation and not just any job? All right, so here's the answer. The answer was between the ages of 60 to 65. The definition is usually an inability to perform the material and substantial duties of your own occupation. Your job requires 75 direct reports, high cognitive load, national oversight, data analysis, team leadership, verbal fluency, high stress and multitasking, virtual communication for hours daily.
 
 Nancy Cavey [00:04:28]:
 And your carrier's vocational analyst knows that this is one of the highest cognitive demand own occupations and in the American industry, your neuropsychological deficits, processing speed, working memory, word retrieval, executive functioning directly impair the core functions of your job. And that makes your case very strong under the own occupation definition. Now here is what we said to that prospective client. And by the way, I don't have a problem discussing this because that question is and all that information is out in the world because he used open ChatGPT. So nothing's private, nothing's privileged in my opinion. But here's what we told this person. I hate to tell you that the answer is not only incomplete, inaccurate, but flat out legally wrong. Yet this person brought us this question answer and wanted to argue with us why ChatGPT was right and why I was wrong.
 
 Nancy Cavey [00:05:24]:
 Sort of like telling the brain surgeon how to remove your brain tumor with without killing you, paralyzing you, or rendering you incompetent. Now I'm sure that you wouldn't want to do that and you shouldn't be doing that using ChatGPT in an ERISA disability claim. But I am going to unpack this wrong answer and explain why you shouldn't be using ChatGPT. So let's take a break. Sa. Welcome back to Winning Isn't Easy how disability carriers or plans really evaluate cognitive impairment short term and long term disability claims. So here's the true response to the question. And this is based on my legal experience, case law and articles that I've written on this particular topic.
 
 Nancy Cavey [00:06:49]:
 So here's my response. It's the eight common reasons used by ERISA disability carriers or plans to deny cognitive impairment claims. So disability carriers like MetLife, Lincoln Unum, or even disability insurance plans dislike cognitive impairment claims. They're going to look for reasons to reject any medical evidence supporting such a claim. They're often going to conclude that the cognitive impairment did not cause a disability because in most cases cognitive impairment is worse immediately after an injury but improves over time. 2. Most people's cognitive impairment from a mild concussion resolves within three months. 3.
 
 Nancy Cavey [00:07:28]:
 Your symptoms have worsened over time which is inconsistent with a normal trajectory and recovery from cognitive impairment. Number four. Your symptoms are largely self reported. Number five. Brain imaging doesn't reveal damage consistent with your injury or your claims of disability. Number six. The objective analysis allegedly supporting your cognitive impairment doesn't have valid measures. Number seven.
 
 Nancy Cavey [00:07:55]:
 You didn't follow through on recommended care that could have alleviated some of your symptoms. Number eight. Your activity is inconsistent with impairments that you claim disable you from performing your own or any occupation. Now I didn't make this up. These are common things that we see in claims denial or terminations. And I'm going to cite you to a case called Proctor vs Unum Life. It's a case out of Minnesota and Proctor was a call center supervisor who was injured in a car accident. She began experiencing cognitive and visual issues and was diagnosed with post concussive syndrome.
 
 Nancy Cavey [00:08:29]:
 She applied for and received long term disability benefits from Unum, but after just one year Unum terminated her benefits using every one of the reasons I outlined above. Now Proctor filed an appeal which was denied and this case ends up in federal court. In Proctor's case, Unum's policy defined disability by focusing entirely on the limitations of the policyholder, not just a faceless somebody on the street that ChatGPT just sort of picked out, if you will. Now the policy repeatedly uses the words you and your and did not indicate that Unum would consider whether the policies policyholder's injury or progression was typical or normal. The court ruled that the correct question was whether this particular policyholder herself was disabled based on sickness or injury. The inquiry was not whether an ordinary person with a similar sickness or injury would be disabled or how a typical person would progress after the event causing the sickness or injury. This is not an everyman on the street standard, but an inquiry about how sickness or injury impacts the policyholder or plan beneficiary. It's not a cookie cutter analysis, much like ChatGPT.
 
 Nancy Cavey [00:09:49]:
 And further, the unit policy indicated that the policyholder would be disabled if they were limited from performing their duties due to sickness or injury. So that means as a practical matter, the carrier plan's determination is made by looking at the combination of all the limitations caused by by the sickness or the injury. And in Proctor's case, she had a cognitive impairment. She had a vestibular disorder with dizziness, visual deficits and headaches. Unum had to consider all of it. The court rejected each of the eight reasons that Unum used to deny the claim and addressed each head on. Unum also tried to justify a claims determination based on the lack of improvement, arguing she wasn't disabled anymore because she wasn't recovering as expected. Go figure that the court noted that while the normal recovery process could inform an analysis, this policy clearly stated the disability would be evaluated solely based on the policyholder's specific limitations, not what might be typical or normal for any type of injury or sickness.
 
 Nancy Cavey [00:10:50]:
 And in this case, Judge Thuman found that Proctor's self reported symptoms as well as the opinions of her treating physicians were credible believable. He concluded the Proctor's inability to concentrate, read, process information on a computer, her difficulty finding words meant that she was unable to perform the duties of her occupation. The judge found that Proctor met the definition of disability and ordered Unum to reinstate benefits retroactively. Now that's a great win. It took a federal judge and years of litigation to get there. So you can see that the ChatGPT answer claiming that a prospective client's case was very strong is wrong. Got it. Let's take a break.
 
 Speaker B [00:11:32]:
 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 [00:12:37]:
 Welcome back to Winning Isn't Easy. Let's talk about the own Occupation Trap and how to win your case. How about the claim that cognitive deficits made this a very strong own occupation claim? Now let's unpack first the difference between your job and your own occupation. When you signed up for your long term disability policy or plan, you probably thought you were ensuring your inability to perform your job and not your occupation. You might be surprised to learn that you didn't ensure your inability to perform the duties of your specific job. In fact, most disability policies or plans are ensuring your inability to perform the duties of your occupation. But the key here is what is the policy or plan definition of own occupation? Now I'll tell You there's no uniform definition. Every policy or plan has its own definition.
 
 Nancy Cavey [00:13:28]:
 Disability carriers will have multiple versions of what appears to be the same policy but with multiple definitions of disability. So there isn't a one size fits all. Even with disability carriers, what's important here is that it could be based on how your occupation is performed for your employer in the local economy, in the national economy, or how your occupation is defined by the outdated Dictionary of Occupational Titles. It's important because many times a disability carrier or plan will determine your occupation based on a job description from your employer. They're going to look at that job description and then try to translate that into, into an occupation based on that description. Don't be surprised if the carrier of the plan's vocational evaluator gets it wrong. So let me give you an example of the own occupation game and why that generic ChatGPT response was wrong. Mrs.
 
 Nancy Cavey [00:14:26]:
 K was a clinical specialist for Candela Corporation, a cosmetic dermatology practice. She was required to travel up to 80% of the time, work 40 hours per week and move equipment up to 270 pounds. And not surprisingly, she developed back problems. She applied for her long term disability benefits through her employer, and that was administered by Hartford. She was paid benefits until Hartford terminated them. And ultimately she appealed. Hartford upheld the termination on appeal. And in upholding the claim's denial, Hartford offered a new support for its denial.
 
 Nancy Cavey [00:15:00]:
 And their initial denial was based on finding that she wasn't disabled from doing her job duties. And in the second denial, Hartford concluded that the medical evidence no longer demonstrated that she could not perform the essential functions of her occupation. So obviously the question here is, well, what was her occupation? Harford determined that her duties included sales support and travel. Sitting or standing up to eight hours, pushing or pulling up to 270 pounds, lifting 25 pounds and carrying 2020 pounds. But guess what? Hartford changed the game by saying that the travel and lifting requirements were not essential to her occupation based on how her occupation was performed in the general workplace. And as a result, they denied her claim. But Hartford redefined the occupation and changed the game. They produced a new occupational report that defined the essential duties of her occupation as a hybrid of 2 dot job descriptions.
 
 Nancy Cavey [00:15:58]:
 They produced a new medical report concluding that she wasn't disabled from performing those new occupational duties. And I will tell you, it's not uncommon for disability carriers to use this hybrid mishmash of occupations to create a claim denial. Now, did the ChatGPT consider this? No. CHATGPT didn't do an analysis of the definition of occupation. It didn't do an analysis of the dots. It didn't do an analysis of hybrid job or occupational descriptions. It didn't do an analysis as to what was wrong with this hybrid mismatch of occupations. So ChatGPT not only didn't, wasn't asked the right questions, wasn't asked the right follow up questions, didn't have the right data to answer the questions, and of course couldn't support or produce any supporting documentation for this wrong answer.
 
 Nancy Cavey [00:16:57]:
 So let's go back to this case. What did the court do with the mishmash of occupational descriptions? So they first looked at the play on which defined occupation to include the employee's vocation as it was recognized in the general workplace and not a specific job that she was performing for a specific employer or at a specific location. Now that's the common definition that you'll see in many disability policies or plans. Remember, you have the burden to prove that you can't do your own occupation. And figuring out what your occupation is based on this definition in the policy is key. Hartford's vocational specialist reviewed the occupational descriptions and arrived at the definition of a clinical product specialist by looking@the dot occupational titles for in this case, general duty nurse and a training representative. Like that is so wrong. Next, they determined the duties of this blended job.
 
 Nancy Cavey [00:17:52]:
 Occupation included no traveling or lifting and only limited exertion to a range of light to medium, which means occasional lifting, carrying, pushing and pulling up to £50. I will tell you, the judge was not happy with this game. The judge noted that the DOT was an appropriate source of the occupational duties, but said, hey, you have to analyze in a reasoned, deliberate fashion what that claimant actually does before determining what the essential duties are of the occupation. Now amazingly, Hartford's VE defined K's occupation by matching DOT job titles to generic descriptions from job placement services. From Indeed, the judge noted that Hartford's ve failed to select dots that approximated her actual responsibilities, including extensive travel and lifting. The judge said, no, you cannot do this. You cannot cherry pick this vocational description and create a hybrid job that doesn't address the material and substantial duties of her occupation. So the judge reversed what are the lessons learned that ChatGPT did not consider? So obviously before you stop work and apply for benefits or appeal a wrongful denial or termination, you should one, get get a copy of the disability policy or plan and learn how it defines the term occupation.
 
 Nancy Cavey [00:19:13]:
 And disability number two, you should be tailoring your medical proof and vocational proof to that occupational description. So in this particular case, she should have been advising, as she did her doctor, that her job required the extensive travel. Preparing for travel, traveling, carrying things, setting up for presentations, giving those presentations, getting back in the car and driving, pushing equipment, and all those things are really crucial to her occupational duties. But there was also this concept of tailoring the medical proof. And by that I mean what are the particular symptoms that the person has from each one of their medical conditions that would impact their ability to do each one of those duties? And, and I like my clients to make a chart of all of their symptoms and then across this chart talk about the location of the symptoms, the frequency of the symptoms, how long they last, and how they impact that particular functioning so that there is this clear correlation, medically and vocationally with an inability to do the material and substantial duties of their occupation, or however that is defined. So it's tailoring the medical and vocational proof. I also want to suggest that you get the employer's description of the job and review it closely for accuracy, because many times you're going to find that that job description has nothing to do with what you're actually performing. And ultimately you should be preparing your description of your job duties, supplementing that, if necessary, with statements from co workers or supervisors.
 
 Nancy Cavey [00:20:50]:
 Now, depending on where you're at in this whole claims process, you, you might want to have a vocational evaluator actually generate a report before you're filing a claim because you might have this mishmash of occupations. And by the way, this is common in Social Security disability cases where a person might be doing what's called a composite job. Now, if the disability carrier misclassifies your occupation or creates this mismatched occupational description and denies your claim, you need to hire an ERISA attorney immediately. You're going to only have 180 days in which to file an appeal. And as part of that appeal, you want to be submitting a report of a vocational evaluator addressing why the carrier plan's determination of your occupation is incorrect as defined by the terms of the policy of their plan, their analysis of your occupation, and why the carrier plan's analysis is wrong. And then in combination with your physician document medically why you can't do the material and substantial duties of your occupation, assuming that's the definition of disability or occupation, it might be. To do so, you have to have a functional capacity evaluation to establish your physical limitations. And if needed, I sometimes will obtain statements from you co workers or supervisors about the occupational duties because I want it to be crystal clear about what the person's occupational duties are are how that's consistent with the applicable definition of occupation, what the specific, subjective and objective problems the person has in performing each of the material and substantial duties of the occupation as that term is defined.
 
 Nancy Cavey [00:22:32]:
 So I'm putting together the medical and the vocational documentation. You can see it takes a team to get disability benefits that you're entitled to, and ChatGPT should not be part of that team. You have 180 days in which to file an appeal and so please, please don't use ChatGPT to do that. Filing a letter simply saying you're appealing won't cut it. And using chatgpt who is not trained on ERISA law regulations, case law is going to be guaranteed to result in a denied claim or an upholding by the disability carrier plan of your terminated benefits. It's just a bad move. Got it? It's time for you to hire an experienced attorney and don't rely on AI tools. So what do you think about those ChatGPT questions and answers? Do you really think you'd get your benefits? ChatGPT is rarely going to give you the right answer because you don't know how it's been trained and it hasn't been trained correctly.
 
 Nancy Cavey [00:23:31]:
 I will tell you, based on my building out of a proprietary AI program that we use in our ERISA disability cases, we have trained it on our arguments on the case law, on ERISA rules and regulations. I know I'm going to get the right answer. And I also, by the way, always ask for proof that I got the right answer. So you don't know the right questions to ask. You don't know the training that Chat GPD has been given. You don't know know enough to be able to understand why the carrier did what they did and how to create either a winning application or to create a winning appeal. So in my view, only an experienced ERISA lawyer can listen to your story, review your policy or plan, review your medical records and answer your questions. And better yet, probably are going to answer questions you never thought to ask.
 
 Nancy Cavey [00:24:25]:
 And more importantly, help to develop a winning strategy to get the disability benefits you deserve. That wraps up today's episode of Winning Isn't Easy. Thanks for tuning in. If you found this episode helpful, please take a moment to like the page, leave a review, share it with your family and friends, and subscribe to this podcast. Join us next week for another insightful episode of Winning Isn't Easy. Thanks, Sam.