Why Should I Appeal A Disability Claim?
Finding out that your disability insurance provider has denied your claim can be frustrating, confusing and frightening. You and your family were likely counting on those benefits to help make...
The attorneys of the Disability Insurance Law Group have prepared a brief guide to facilitate understanding of how private disability insurance works.
If your claim is denied, in many states you may be required to submit a demand for payment to your insurance company prior to filing suit. Even if the law governing your state does not require you to submit a formal demand, doing so may often be a good idea.
Many denials or delays in payment of a claim can be overturned without ever filing a lawsuit, simply by bringing forth the right information and pointing out the flaws in your insurance company’s reasoning. This is often a more expedient, less frustrating and more cost effective resolution than immediately filing a lawsuit.
It is essential that you understand your rights and obligations under your policy and the law, as well as the tactics frequently employed by insurance companies to support a delay or denial of a claim before you proceed. Nevertheless, if your insurance company refuses to act reasonably, filing a complaint with your state insurance commissioner and ultimately a lawsuit in court may be necessary.
At Disability Insurance Law Group, we are known for our aggressive representation of clients in and out of the courtroom. Such clients include doctors, lawyers and other professionals. Insurance companies have their best interest in mind, someone should have yours. If you are considering applying for disability insurance benefits, have already applied and your claim has been denied or delayed, or are on claim and interested in a buy-out of your policy, we would be happy to provide you with a free consultation of your claim.
Own Occupation Disability Insurance Policies — These policies have definitions that provide benefits if, as the result of sickness or injury, the insured is unable to perform the substantial and material (main, major, primary) duties of your regular occupation. Your regular occupation is usually defined as the occupation in which the Insured is engaged at the time he/she becomes disabled.
True Own Occupation Policies — These policies pay disability benefits even if the insured is working in some other occupation (even within the same field), provided he or she remains unable to perform the material duties of his/her own regular occupation.
Modified Own Occupation Policies — These policies limit the time benefits are payable under the own occupation definition and will not pay benefits if the insured is engaged in any other occupation – even if he/she is not able to perform the substantial and material duties of his/her own occupation. However, many states have limited this by state statute. Accordingly, even if your policy indicates that you are disabled if you cannot perform the duties of your regular occupation and are not working in any occupation, you may be able to work and earn income in an alternative occupation for a period of time and remain disabled under your policy.
Any Occupation or Gainful Occupation Coverage — Many group disability policies offered by professional associations, such as the American Medical Association, American Dental Association and American Bar Association, provide benefits under a true or modified own occupation definition for a limited period of time (typically two years). However, after disability benefits have been paid to the insured for that period of time, he/she only remains eligible for disability benefits if due to sickness or injury you are unable to perform the duties of any (gainful) occupation for which you are deemed reasonably qualified by education, training or experience. While this may seem extremely limiting, many policies contain language which indicates that the insurance company must consider the individuals actual qualifications, work experience and/or pre-disability income.
If you are dealing with an individual or private disability insurance policy, you may find these links helpful:
If you have questions regarding an individual disability insurance policy or need help to file a claim or challenge a denial of benefits, contact our offices in Florida by email to arrange for a free initial in-person or telephone consultation. We will listen to your concerns, evaluate your case and advise you of your legal options.
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