Our Firm often receives inquiries from individuals who are currently working, but due to the nature of their particular illness or injury the possibility of filing a disability claim at some point in the future appears inevitable. They are relying on their disability policy to provide them with the financial support they will need once they can no longer work. It is therefore, extremely important that they maintain coverage under that policy and qualify for the highest benefit possible if and when they must file their claim for benefits.
Understanding a Policy’s definition of disabled/disability and what is required to maintain coverage under your disability policy is crucial, as a decision to change your work related duties, reduce your hours, work from home, resign, sell or close your business could impact the amount of your benefit or result in a total loss of coverage. Under most policies, disability is based on your occupation at the time of disability. Thus, the decision to reduce your work hours or change your job duties in order to continue working may impact the way your claim is evaluated and whether or not benefits are paid.
Under employer provided disability policies (ERISA policies), significant coverage issues arise when an employee, knowing they cannot work much longer but not wanting to leave their employer in a bad position, reduces their hours and advises that they plan to resign on a specific date. Because the employee is only covered if he or she becomes disabled while an employee and/or while working a minimum number of hours per week or month, the decision to work less or resign on a specific date may result in a determination that the employee was not covered under the disability insurance plan on their date of disability.
Under individual disability policies, the insured will maintain coverage as long as they pay the policy premium. Many of our clients with individual policies own their own business and have worked hard to make that business successful. Unfortunately, at some point their medical condition forced them to work less and consider either selling or closing their business. It is equally important for these individuals to be aware of their policy’s provisions and how their benefit amount could be affected by the decision to work beyond their physical or mental capacity. If the claim is not properly documented or worked up, insurance companies will find reasons to reduce the benefit or deny the claim outright.
In addition to speaking with someone about the terms and provisions within your disability policy, it is important to talk to your doctor. Your doctor needs to be supportive of your decision to take a medical leave because the insurance company will request your medical records and may even contact your doctor for an interview about your medical condition. While many of our clients have worked for years despite having a serious medical condition such as Multiple Sclerosis, Lupus, degenerative disc disease, HIV, knee and hip replacements, they ultimately became unable to perform job duties and their treating physician advised them to slow down and/or stop working because their symptoms, which were once manageable, had now become debilitating. Making sure your medical history and condition is accurately reflected in the medical records and that your doctor is aware of your limitations and supportive of your claim will make the application process less stressful and more efficient.
At DI Law Group we help many of our clients prepare for the possibility of a disability claim and work with them to make sure that if and when that day does arrive, the application and claims process is smooth and benefits are paid as quickly as possible. Please feel free to contact us with any questions about a potential or current claim for disability benefits. We represent clients who are preparing to file a claim, have filed a claim and benefits have been denied or terminated, are in need of our help to administer their existing claim, negotiate a lump sum buy-out of a claim, or litigate their claim in court.