Long-term disability insurance is intended to provide an income for people who have been disabled and unable to work. Many large corporations include disability insurance as part of their employee benefit package. Small businesses owners purchase these plans to provide family and employees who are dependent on their employment for their livelihood.
Individuals can purchase private disability insurance to provide peace of mind and financial coverage in the event of a disabling condition. Professionals such as surgeons or entertainers may pay for a special policy that allows for benefits if they are disabled from doing the specific job they were trained for.
In the past there was no regulatory body, for disability insurance, so wording can vary between policies. Although there can be similarities at a quick read through, the difference between exact terms and definitions are significant.
It is not uncommon for clients to be denied by their insurer. Many clients report feeling entirely overwhelmed with the complicated wording used in insurance policies. Many of our clients were originally denied disability insurance before asking calling us for help.
Terms and Definitions
Most policies specify a time period of “Own occupation” coverage.
To be eligible for long-term disability insurance under the terms of “own occupation”, the client must be “totally disabled” from doing the job they were doing, at the time the disability originated. Insurance companies are well versed in the wording of their policies and do not always explain it to the client’s benefit.
What if my policy stipulates “total disability” as a pre-requisite for benefits?
The term “total disability” may be interpreted in different ways, depending on the particular policy. It is usually understood to mean reasonably disabled regarding the person’s ability to do the job properly and without further injury or damage to him or herself.
Insurance companies often focus on parts of the job that the disabled person is able to do, highlighting capability as an argument to deny benefits. Past disability cases have shown that the plaintiff does not have to be completely helpless in order to be defined as “totally disabled” for the purposes of the “own occupation period as stipulated in the policy. “Total disability” in this case, means the client is not able to do the necessary duties required within the context of his own occupation. This could mean the client can do some duties but not all. If further disability results from the clients attempt do some, or all of his regular duties, he would be considered “totally disabled “within the context of “own occupation.” An experienced disability lawyer will spot clearly defined terms and areas of your policy that are open to interpretation.
Many disability insurance policies have a two-year limit on total disability regarding own occupation. After this point you will be asked to consider “any occupation” that you are educated or trained for, and have the experience to do, or could be trained for.
You must provide the details of your illness regarding diagnosis, doctor’s reports, diagnostic testing, reports from health and alternative health care professionals, treatments that were or were not effective. Keep all receipts and contact information. This information is necessary to help prove your disability and support your position in the event your case goes to court.
It is helpful to keep dated records of the following:
• Medical check ups and doctor’s visits
• Brief description and duration of pain and symptoms
• Conversations with your doctor or medical personnel
• Conversations and correspondence and names of insurance personnel
In addition to the medical tests and diagnosis you currently have, insurance companies routinely pay independent medical professionals to administer further tests. Clients may be required to travel out of town, in order to get to appointments, which can take 5 to 8 hours to complete. These tests may come back with questionable findings. It is not unusual to be treated as if you are “faking” your disability. If your case goes to court your disability lawyer will assure that any questionable test results are scrutinized and held to strict standards by professional medical witnesses.
In order to be eligible for long term insurance benefits you must be able to prove that your condition makes work not possible. You will be asked about the responsibilities of your current occupation; and how your disability prevents you from carrying out necessary duties. Areas of disability include physical, emotional, mental and social. Keep track of all disabling conditions and what situations cause it.
It is common for insurance companies to collect client evidence by using surveillance. Video cameras record and take every opportunity to point out inconsistencies between your stated disability and your daily activities. By using these tactics, the insurance company hopes to prove malingering by tarnishing the client’s credibility. In this way they can refuse or reduce the amount of money they are required to pay the plaintiff.
Do time limits apply?
Time limits apply. There is usually a waiting period before the disabled person is eligible to receive financial benefits. It is important to contact the human resources department at the workplace as soon as possible to start the ball rolling. Clients should be prepared with dates and details regarding their disability. This includes medical appointments and reports, as well as names and contact information for heath care providers. Independent policy owners should contact their insurance provider.
Many clients have paid thousands of dollars into long-term disability insurance, only to be turned down when they need it. Insurance companies have a legal right to question the authenticity of claims and they have many years of experience in the process of denying rights to benefits. Deserving people are wrongly turned down and accused of malingering or faking. Reports made by insurance personnel, should be carefully read, before adding your signature.
If litigation is necessary, independent medical examinations must be able to stand up in court under the watchful eye of legal /medical professionals and cross examinations by experienced personal injury lawyers. Professional witnesses can shine a new light on arguments made by the insurance company.
If you have been denied long-term benefits, it does not mean you do not deserve benefits or that the insurance company was correct in their ruling. In many situations, insurance companies change their decision immediately upon finding out a client has experienced legal backing.
We offer no charge consultations and case assessments. No up front retainer is required. You pay no upfront fees until your disability claim is settled and we have recovered compensation for you.
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