Disability Insurance

• February 26 2018
• |   Disability Claims

Disability insurance is used to protect yourself if you can’t work because of illness or injury. You can buy disability insurance for peace of mind so that you can provide for your family if you get sick or have some kind of illness or injury and can’t work for a certain amount of time.

Reasons Insurance Companies Will Deny A Disability Claim

A common ground insurance companies use to deny disability claims is the insurance company will claim the claimant can go to work or that the injuries or illness aren’t bad enough to prevent them from going to work. Another common reason is insurance company will claim there is no objective evidence that you are sick and it’s all self-reported. You see that in entries where the doctors have reasoned that they are ill but there are no scientific or medical tests — just self-reporting. The insurance company will claim that is not sufficient. The insurance policy or the promise, if you will, however, doesn’t require there to be objective evidence of an illness. We represent individuals who have had their claims denied when that denial is not supported by the facts or the supported by the language of the insurance policy.

Q: If the insurance company is making an argument that it is isn’t objectively verifiable, how do you argue against that?

First, one of the main arguments is that the insurance policy doesn’t have a requirement for objective evidence. There is usually nothing in the actual policy sold to the individual that says you can only collect for objective illnesses or injuries. Second, you don’t need to argue that there is no requirement if there are a couple of doctors agreeing to the disability, and other individuals know they can’t perform the functions of the job. So, you kind of change it from the individual reporting, to other people who know he or she is unable to perform the job.

Q: Does it ever come to the point where you’ve got insurance company experts disagreeing with your expertise. And then who is the final arbiter — is that a jury?

It depends on the person. The policy and the claim will most likely be presented and the jury will decide. But if it is an employee benefit, then the Employment Security Act would apply in that case.

The judge will decide whether or not the insurance company who is denying the claim made a decision with the arbitrator on whether they made the right decision.

Q: What does an insured person do when his or her insurer denies a disability insurance claim?

The first thing you should do is talk to an attorney. Bring your file and insurance policy and then the attorney can analyze whether the denial was correct or whether you can appeal.

Q: Is it possible to sue for other types of damages or attorney’s fees if it’s found that my disability claim was wrongfully denied?

If they denied your claim wrongly and it was a policy that was bought by an individual on their own by themselves, they can put in a claim for bad faith. If it is an employee benefit covered by the state or if you’re employed at a church, there could be more exceptions.

Q: Is it possible that the judge may award attorney’s fees to my employer and that I will end up paying someone else’s attorney’s fees?

That is a possibility. However, in bad faith situations, there have been instances such as in California, where if you breach the contract and breach of bad faith, you could get attorney’s fees on breaching the contract. So, yes there is a potential of having attorney fees. There is also a potential of getting damages for your emotional distress.