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February 2017 Archives

Own Occupation vs Any Occupation Disability Policy Definitions

Many group and individual disability insurance policies provide protection in the event that a claimant cannot perform the material duties of their Own Occupation ("Own Occupation Period") for a limited period of time (typically 24 months). In many policies, after the Own Occupation Period expires the definition of Total Disability changes to the inability to perform the duties of any gainful occupation ("Any Occupation Period"). Occasionally, this definition will include an Earnings Qualifier, which means that if the claimant can work in another occupation, but cannot perform the duties of an occupation that would allow him or her to earn a certain percentage of their pre-disability income, they would still be considered Totally Disabled.

A Short Term Disability Denial or Determination Delay Does Not Preclude a Claim for Long Term Disability Benefits

Many insureds are discouraged from pursuing a claim for long term disability benefits prior to receiving an approval of short term disability benefits or after receiving a submitting an appeal of short term disability benefits. A potential problem with simply waiting for the approval of short term disability benefits, especially where the insurance company is dragging out the review process, is that information pertinent to both the short term and long term disability claims is not being submitted and considered by the insurance company and the likelihood of a denial of both claims increases. In the case where short term disability benefits have been denied, submitting an appeal along with a claim for long term disability benefits could very well result in the approval of both.

Partner Alicia Paulino-Grisham Selected by American Conference Institute to Speak at the 20th National Advanced Forum on Litigating Disability Insurance Claims in Miami, Florida.

On February 1-2, 2017, the American Conference Institute ("ACI"), one of the leading organizations on educating the insurance industry, conducted its 20th National Advanced Forum on Litigating Disability Insurance Claims. Alicia Paulino-Grisham was honored to again be invited to participate as a Speaker.

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