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Disability Insurance Law Blog

Insurer ordered to pay fees after denying disability benefits

Many people in Florida and elsewhere in the country have faced serious hardship after their applications for disability benefits were denied by their insurance companies. One firm, Life Insurance Co. of North America, was found to be liable in its treatment of a woman with chronic pain to whom it denied disability benefits. The insurer is a subsidiary of Cigna, a larger life and health insurance firm with customers across the country. A U.S. Court of Appeals for the 6th Circuit decision ordered the company to pay the woman's attorney's fees after she was wrongfully denied benefits.

According to the court's ruling, the company failed to physically examine the woman but discounted evidence she provided of her chronic pain and other disabilities. The company also changed the targets that she needed to meet in order to be deemed eligible to receive disability benefits. A lower court had previously ruled that each party was responsible for its own legal costs, but the panel of the higher court said that the insurance company's behavior was so bad as to warrant reversing that decision.

When insurance companies deny professional disability claims

A professional may face difficulties when attempting to bring a claim to a disability insurer. Doctors, lawyers, business owners, and other skilled professionals work hard and spend significant sums of money to make sure they have disability insurance policies that will protect their family and financial well being should an injry or illness prevent them from being able to work.  Despite timely paying premiums, when the time comes to file a claim after an accident, injury or significant health event, the insured too often faces delays, ongoing requests for information, and a denial of claim.  Disability insurance companies, while happy to take premium payments,  look for reasons to deny benefits, especially for high-earning professionals.

In some cases, an insurer may assert that the professional is not disabled enough to receive benefits because they conntinue to perform or could still perform a minor portion of tier prior work, despite the fact that they remain unable to perform the primary duties that allowed them to earn a living.  In those cases, the insurer will claim that the professional is only "partially disabled" rather than "totally disabled," in an attempt to pay only a small percentage of the monthly benefit.  Under most individual policies taken out by professionals and business owners, the ability to perform a small percentage of their prior occupational duties does not disqualify them from being eligible for total disability benefits.  Many of these policies state that if the insured cannot perform the "material" duties of their occupation then they are TOTALLY DISABLED.  Thus, a dentist that normally performed numerous dental procedures each day but can now only review x-rays and provide treatment recommendations would still be totally disabled.  

If you have any questions about a potential claim, current claim, or your policy, plesae do not hesitate to contact us at (888) 644-2644 or through our website at www.dialwgroup.com. I can also be contacted directly at [email protected] 

Are you under surveillance by your disability insurance company?

Surveillance is a frequent tool used by disability insurance companies to try to deny or terminate claims. We often hear from claimants: "I have nothing to worry about, because I am actually disabled. Let them follow me;" "I would know if I were under surveillance;" and "my claim is not worth enough for my disability insurance company to pay to surveil me." Unfortunately, these common misconceptions about insurance company surveillance all too often result in claimants being stunned that their truly deserving claims have been denied or terminated.

Claim for short term disability leads insurer to change policy

As more people are becoming accepting of transgender surgery, insurance companies are changing policies. In this vein, a major disability carrier recently did so after initially denying a claim. This is good news for the transgender community in Florida as many are hoping other carriers follow suit.

In a recent case in Massachusetts, the claimant filed for short term disability due to male-to-female transition surgery. The recovery time was estimated to be four to six weeks. The claimant's policy paid short-term benefits after seven working days. However, 'elective surgery" was listed as an exclusion under the policy. The type of procedure undergone by the claimant was considered elective by the carrier.

Are you under surveillance by your disability insurance company?

Surveillance is a frequent tool used by disability insurance companies to try to deny or terminate claims. We often hear from claimants: "I have nothing to worry about, because I am actually disabled. Let them follow me;" "I would know if I were under surveillance;" and "my claim is not worth enough for my disability insurance company to pay to surveil me." Unfortunately, these common misconceptions about insurance company surveillance all too often result in claimants being stunned that their truly deserving claims have been denied or terminated.

What you need to know before submitting an appeal of your group short-term or long-term disability insurance claim...

Before you submit an appeal of your group short-term ("STD") or long-term ("LTD") disability claim, it is essential that you understand your obligations and rights under the applicable law. What you do not know, could hurt you!

Most group STD and LTD claims that you receive as a product of your employment, whether you pay the premiums or your employer pays the premiums, are governed by the Employee Retirement Security Act of 1974 ("ERISA"). ERISA is a federal statute that places strict deadlines and requirements on beneficiaries in pursuing a claim for STD or LTD benefits. It is imperative that you meet the strict deadlines in submitting a claim, responding to requests, appealing a denial, or filing a lawsuit, as failure to timely meet these deadlines could be fatal to your claim.

Private disability claims are often denied

There is a great disparity in how people think about insurance. Many Florida residents think of it as a necessary evil and purchase the minimum required for specific purposes, while others seek to protect themselves against risk by acquiring upgraded and broader coverage. For example, it is not uncommon for relatively young individuals to buy life insurance, yet, statistically, a disabling injury or illness is far more likely than an early death. However, when it comes to collecting on a filed claim, disability insurers often delay, offer low settlements, or deny the claim altogether.

The first consideration disability experts suggest is to determine one's anticipated needs. For example, employees may be covered by workers' compensation, state disability, or employer-paid policies. To the extent some or all of those are available, it also must be calculated what percent of income each replaces. Purchasing a private disability policy makes sense for many who could not maintain their lifestyle on the replacement income.

What does your policy's declaration page do for you?

Most Florida residents rely on the insurance company they work with to get their policies right. After all, they may not feel as though they have a choice in purchasing insurance in the first place, so they discuss coverage options and begin paying premiums.

However, insurance companies do make mistakes. They may omit something you thought you purchased, put in wrong numbers or make some other error that could end up costing you in the future if your insurer denies a claim.

Liberty Insurance forced by Court to pay LTD Benefits for Anxiety and Bipolar Disorders

In May 2015, Wells Fargo & Company (Wells) hired Rosa Ramirez as a Financial Crimes Specialist. Shortly thereafter, in August 2016, Ms. Ramirez stopped working at Wells after suffering a mental breakdown following an altercation with her manager. Thereafter, due to her worsening depression and anxiety since starting her new job, Ms. Ramirez applied for short-term disability benefits and in September 2105, Liberty Life Assurance Company of Boston (Liberty) approved her claim. Later in December 2015, Ms. Ramirez was diagnosed with Bipolar Disorder, Post-Traumatic Stress disorder, Anxiety and Major Depressive Disorder. Additionally, her treating physician opined that she required a high level of care given the severity and chronicity of her mental illness. Accordingly, Ms. Ramirez was referred to Daymark Recovery Services (Daymark). Shortly thereafter, Ms. Ramirez had her initial assessment and despite some initial improvement Ms. Ramirez regressed and under her doctor's recommendation, filed a claim with Liberty for long-term disability benefits (LTD benefits) and was approved in March 2016. In May 2016, however, Ms. Ramirez' condition worsened as she began to experience violent thoughts and act abnormally. Accordingly, Liberty re-reviewed Ms. Ramirez' claim and extended her disability benefits through July 31, 2016 because she was unable to perform nothing more than activities of daily living. In August 2016, Ms. Ramirez' doctor completed Liberty's restriction form due to her condition.

A disability insurance claim denial need not be the last word

Having insurance coverage can provide peace of mind. The hope, of course, is to never have reason to file a claim, but the expectation is that if a loss occurs, the insurance company will respond in a timely manner, address the issue professionally and pay an appropriate settlement amount to cover the damages incurred. However, when it comes to disability insurance claims, many Florida claimants find that the reality of how the insurance company handles the matter is far different from their expectations.

Although there are three different types of disability insurance an individual can have, legal experts report a high incidence of denial of benefits from all three. For both Social Security disability and employer-provided disability insurance, which is governed by federal ERISA laws, the right to appeal a denial is guaranteed. Where private disability insurance is involved, most allow some form of appeal, but it will be necessary to verify this by reviewing the specific language and terms of the contract.

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