What is a Private Disability Insurance Policy/Claim Dispute?

With a recent estimate suggesting that nearly 1 in 5 Americans has a disability of one form or another, greater attention than ever is being paid to the role of disability insurance. While many individuals who are covered by disability insurance have secured such coverage through programs sponsored by their employer, there are others who have chosen to purchase private insurance directly through a carrier or an agent. They do so in order to protect themselves against a sudden and perhaps lengthy inability to work due to illness or injury.

The frustrating truth of the matter, however, is that many such policyholders find that they have paid costly premiums, often for years, only to have the insurance company deny their claim for benefits. When this occurs, it may be necessary to do battle with an insurance company that is willing to pull out all the stops in order to prevent benefits from being paid.

Because the process of confronting such a carrier is certain to be a fact-intensive, detail-oriented endeavor, it is best to secure the aid of a private disability lawyer who is intimately familiar with the way insurance companies operate and the methods they employ to unfairly deprive claimants of the benefits they deserve.

Private Disability Insurance Policy Benefits

Private disability insurance benefits provide for disability both on a short term and long term basis. They are either provided for by your employer (known as ERISA based policies) or those that you purchase on your own accord. Short term benefits usually last 3 to 6 months, and long term benefits usually involve a waiting period and continue until you reach the retirement age of 65.

Most private disability insurance policies provide for benefits if you become totally disabled. Some private policies base a finding of disability upon a similar standard to that of the Social Security Administration, i.e., unable to perform substantial gainful activity for a continuous and sustained basis expected to last at least a minimum of one year. However, some policies, unlike Social Security disability, may provide that you may recover benefits if you are unable to perform your specific occupation.

If Denied Based on a Claim, Immediately Obtain Counsel

Oftentimes, while there is an appeal process after applying through your insurance carrier, it is essential that the insurance carrier be provided complete documentation as to your disability, as the standard for review is very different than that of Social Security. It is therefore important that your disability insurance carrier be provided as complete a picture of your limitations as possible prior to their final determination. It is essential that you have the full support of your treating physicians. It will be necessary for your doctors to provide adequate documentation to the insurance carriers and that your treatment notes reflect the full nature and full functional limitations of your symptomology. It is important that you obtain advice from an attorney as soon as the process starts. Oftentimes, we can provide additional information and forms which are essential for laying a proper foundation for you to ultimately be successful. Often, we can also provide a video presentation to your insurer which fully demonstrates your functional limitations. If after final internal review your insurance carrier has still denied your claim, you may appeal the matter to Federal Court.

It is important to note that private disability benefits and Social Security benefits are mutually exclusive. This means that you may be able to receive one without receiving the other. Almost all private disability policies require you to apply for Social Security benefits as a condition of receiving benefits under their policy. If you are applying for private disability benefits, it is advantageous to immediately contact a professional who can help and fully explain the process. It is a complicated process, and it is extremely advantageous to be represented by a disability expert.

All claims are handled and/or overseen by a former employee of the Department of Health and Human Services with over 20 years of experience representing claimants.

The Crucial Role of a Private Disability Attorney

Few things are more devastating to a family’s well-being than the onset of an injury or illness that prevents the household’s primary breadwinner from continuing to work. For most, the loss of income stemming from such an event would be financially crippling. To safeguard against such an outcome, many decide to purchase private disability insurance policies designed to replace at least a part of the missing income in the aftermath of the disabling event.

Aggressive Advocacy in the Face of Private Disability Insurance Disputes

Because policies of this type tend to be sold to high earners working in professional capacities, the benefit amounts to which successful claimants would be entitled are generally quite substantial. For this reason, carriers who sell private disability insurance policies are renowned for taking all available opportunities to deny and defeat claims. A private disability lawyer understands the tactics routinely employed by insurers seeking to evade their responsibility to policyholders and will take specific steps to ensure that benefits are paid.

Private Disability Insurance Carrier Tactics

Attorneys working in the realm of private disability insurance claims know the lengths to which carriers will go to prevent policyholders from receiving the benefits they are owed and for which they have paid. For insurance companies, the name of the game is to deny claims whenever possible, often with little regard to the manner in which it is done. Common methods used by carriers include:

  • Scouring policy applications and medical records for evidence of preexisting conditions that could be connected in any way to the claimed disability;
  • Attempting to find any justification for rescission or retroactive cancellation of the policy;
  • Seeking irrelevant and extensive personal data (such as tax records) in order to argue that income estimates have been inflated in order to boost benefit levels;
  • Demand that claimants be examined by doctors paid by the carrier;
  • Hire private investigators in an effort to secure proof of fraud.

By enlisting the help of a practitioner with extensive experience dealing with insurance companies committed to stopping at nothing in order to deny a claim, a disabled party can significantly enhance his or her ability to obtain the financial benefits due.

Bad Faith Litigation and Insurance Coverage Disputes

When an insurance company refuses to pay in the aftermath of an illness or injury resulting in significant, long-term impairment, it is important for a policyholder to promptly begin exploring and fighting back against the purported reasons underlying the denial. While an employer-sponsored disability insurance plan falling under ERISA regulations will have a clearly-defined appeals process available, when it comes to private coverage, a thorough understanding of the specific plan documents is key. Certain carriers provide for appeals of initial denials, whereas others may demand additional filings in order to facilitate reconsideration.

Holding Private Disability Carriers Accountable

If it becomes apparent that an insurance carrier is unwilling to budge on its decision to deny benefits in a given case, a policyholder may choose to initiate bad faith litigation, seek to have his or her coverage dispute heard in a court of law and potentially receive punitive damages if successful. Under any of these scenarios, the knowledge and experience of a seasoned private disability attorney will surely prove invaluable to a claimant’s chance of securing a positive outcome.

Obtaining the Assistance of a Private Disability Lawyer

There can be little doubt about the devastating impact on a family’s finances a long-term disabling condition is almost always certain to have. The injustice of such a circumstance is all too frequently compounded when a private disability insurance carrier refuses to pay benefits to which the policyholder is rightly entitled. If your family has experienced this type of misfortune and you are committed to asserting your rights, we invite you to contact a private disability lawyer with Young, Marr and Associates at 1-(609) 755-3115 for a no-cost evaluation of your claim.

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