Examples of Disability Claims

• March 12 2018
• |   Disability Claims

Q: What if I have disability insurance and because of my wrist injury I can no longer perform surgery and I have to be a regular doctor. Or perhaps I’m a professional athlete and injure one of my knees, and I can do anything else in the world, but I can no longer be running back on a football field. What do those disability claims look like?

Policies will typically pay if you are disabled from your own occupation, so if you can’t be a running back, you could be paid x amount a month or whatever percentage of your prior income that they promised to pay you. Most policies cover your own occupation for a period of two years and then they switch to any occupation that you are skilled in, trained in or have an education for.

A lot of people get kicked off claim or, in other words, the insurance company terminates benefits, when their policy switches from own occupation to any occupation definition of disability. For the football player who hurt his knee, they may pay you for two years if you can’t be the linebacker anymore but if the linebacker graduated from college the insurance company may claim he can perform another occupation because of his education and kick him off claim.

Q: As an experienced disability insurance claim lawyer, is there any argument against that?

It depends on what the insurance company is saying about the individual’s skills, training or education. The insurance companies always hire what they call a vocational skills expert and that individual hokes up five jobs in your market area that the individual can allegedly do. Often those jobs don’t exist, or the individual can’t actually do them. So, when looking at whether to challenge the insurance company’s termination of benefits, we look at whether the jobs selected by the insurance company are realistic with the individual’s skills, training and education, as well as the individual’s functional limitations.

The other thing I look at depends on every job that is rated on a community level. So obviously a football player might be ready and say he gets hurt you know he has to press through college and get a job at finance, it will be hard to argue that he cannot take that job. But say the job he had was a heavy duty job and the individual never graduated from high school and has no other training or experience. The insurance company says that he can perform a light duty job, or a sedentary duty job, but it might not even be a possibility. It just depends on the scenario that you have to look at and see what they are telling you and if the individual can do it.

Q: If they say that I would be able to work in any of these five occupations but if there are none of those jobs available in my community can they still prevail the argument?

It depends on what the policy language says. For example, they can’t say well you know there are no jobs in Reno but there is a job in Las Vegas so he should be working there. I don’t think that is appropriate, but it really comes down to the language of the policy.