Odds are you’ve spent long hours searching for the right auto or homeowner’s insurance, but what about disability insurance? Disability insurance offers an extra layer of financial protection by replacing your income when you're not able to earn it due to a disabling injury or illness. Some think of it as “paycheck protection.” Others view it as “mortgage protection.” Whatever your mindset, disability income insurance can help provide a sense of security, knowing that if the unexpected should happen, you’ll still receive a monthly income.
DISABILITY INSURANCE TYPES
- SHORT-TERM DISABILITY INSURANCE replaces a portion of your base salary, usually 60% to 70%, up to a monthly dollar cap under employer-sponsored plans, for a specified period. It usually pays out for less than six months but could last up to a year after an illness, injury or childbirth. There may be a waiting period of up to two weeks after you become disabled before the benefits kick in.
- LONG-TERM DISABILITY INSURANCE replaces a portion of your base salary, usually 40%- 60%, up to a monthly dollar cap, such as $10,000. The benefits end when the disability ends. If you remain disabled, benefits may end after a specified number of years or last until you reach retirement age, depending on the policy. Some policies also provide payment for additional services, such as training to help you get back into the workforce after a disability. A long-term disability insurance plan also has a waiting period. The length varies by policy, but a common period is 90 days. The waiting period is typically timed so the benefits kick in when the short-term disability insurance ends.
FILING A DENIED DISABILITY CLAIM
Filing a claim for disability doesn't guarantee that you will receive benefits. In fact, only about one-third of Social Security disability claims are initially approved. Claims can be denied for a variety of reasons. One of the most common ways insurers avoid providing benefits is by contending that there's insufficient medical evidence to demonstrate disability. This is most common when there has been a lack of regular medical treatment, and thus no extensive medical file documenting the disability, missing medical records, or an inadequately detailed doctor's statement. Failure to meet the policy's definition of disability may also result in a denial of benefits. Additionally, plans may exclude coverage when medical disability is related to conditions such as drug or alcohol abuse. Insurance providers have a financial interest in denying disability claims. Insurers generally have their own staff of doctors they can depend on. In addition, there's no presumption that the opinion of a claimant's treating physician deserves more weight, so the insurer can rely on its own doctors and vocational experts to deny a claim that might otherwise be medically justified.
BAD FAITH DISABILITY INSURANCE
It is not at all uncommon to see an insurance company commit bad faith in processing and handling claims for benefits under a disability insurance policy. This is often seen when insurance companies conduct an investigation that is not designed to determine the truth but is instead solely designed to find a way to deny the claim. Often times insurance companies will rely upon a report from a biased doctor (to whom they pay large sums of money) who has never even seen or examined the insured, even though numerous doctors who have actually treated and examined the insured on a regular basis say otherwise. At Fulmer Sill, we have also seen situations where an insurance company, while not contesting that a person is disabled, calculates the amount of monthly benefits the insured receives in an inaccurate or inappropriate manner. These tactics are illegal and should not be accepted. At Fulmer Sill, we hold insurance companies responsible for these actions. Insurance companies acting in bad faith are often guilty of the following:
- DENYING A CLAIM WITHOUT REVIEWING CRITICAL SECTIONS OF RELEVANT MEDICAL RECORDS.
- DENYING A CLAIM BASED ON A CONTRARY STATEMENT IN THE CLAIM.
- EMPLOYING MEDICAL EXPERTS WHO SPECIFICALLY SUPPORT CLAIM DENIALS.
- DELIBERATELY WITHHOLDING SPECIFIC MEDICAL INFORMATION FAVORABLE TO A FINDING OF DISABILITY FROM THEIR MEDICAL EXAMINER.
- PROVIDING MEDICAL EXAMINER WITH A DEFINITION OF DISABILITY THAT DOES NOT MATCH STATE LAW OR DEFINITION IN THE DISABILITY POLICY INTSELF.
- APPLYING MASS STANDARDS TO AN INDIVIDUAL CASE.
DO YOU NEED HELP WITH A POTENTIAL DENIED DISABILITY CLAIM?
If you or a loved one have been affected by Denied Disability, we encourage you to consult with our team as soon as possible. With our extensive knowledge and expertise, you can rest assured that should you choose to work with us, you will have legal representation that you can trust. At Fulmer Sill, all initial consultations are free, and we don’t charge any up-front fees for representation. We handle all fees on a contingency basis, meaning that unless we’re successful, you don’t have to pay us. Please contact Fulmer Sill at (405)510.0077 for a free consultation.