What do I do if Disability Insurance Denies My Claim?
You are much more likely to become disabled during your work life than to die during your work life. Thus, disability insurance is very important to protect you and your family from financial ruin in the event of a disability. But, what happens when you insurance company denies your disability claim?
Short-term disability (STD) policies usually pay you for a short period of time, say six months, to help you during short-term illnesses or accidents. Long-term disability (LTD) policies provide coverage for longer periods. Policies vary, but a typical LTD will pay you for the entire period of disability or until a particular age, say 62 or 65.
There are two types of disability policies – “own-occupation” and “any-occupation.” Own-occupation policies generally define disability as the inability to perform the material duties of your own occupation at the time you become disabled. Any-occupation policies generally define disability as the inability to perform any occupation.
Florida law requires a disability policy to be an own-occupation policy for at least the first 12 months of disability. After 12 months, if it was designed to be an any-occupation policy, it will become so.
Many insurance companies have tried to equate the term “totally disabled” with “totally helpless.” In effect, they will argue that you are not totally disabled unless you are totally helpless. In Florida, you will be considered totally disabled under an own-occupation policy if you are unable to perform the material and substantial duties of your regular occupation. Under an any-occupation policy, you will be considered totally disabled if you are unable to perform any work or occupation for which you are reasonably qualified or trained. These are minimum standards in Florida. An insurance company can write a policy that is more favorable to the insured, but not less favorable.
Suppose an insurance company denied a disability claim by asserting that there is some menial job you can do. Courts have determined this is not sufficient grounds for the insurance company to deny your claim. The court will take into consideration the wages you earned before your disability in comparison with the wages of the job the insurance company is proposing that you can now do. Courts have said that even if you can perform some job, you should be entitled to recover disability benefits if you cannot earn a wage that approaches “the dignity of a livelihood.”
One court has recognized that: “Common knowledge of the occupations in the lives of men and women teach us that there is scarcely any kind of disability that prevents them from following some vocation or other, except in cases of complete mental incapacity. Although the achievements of disabled persons have been remarkable, we will not adopt a strict, literal construction of such a provision which would deny benefits to the disabled if he should engage in some minimal occupation, such as selling peanuts or pencils, which would yield only a pittance. The insured is not to be deemed “able” merely because it is shown that he could perform some task.”
If your insurance company denies your claim or terminates your benefits, you immediately should contact an attorney who handles disability claims. Such an attorney should agree to review your case for free. Most importantly, a Florida statute requires the insurance company to pay your fees and costs if you are successful against your insurance company. This statute is a powerful tool in leveling the playing field between you and the insurance industry.
At The Nation Law Firm I will look at any disability claim denial for free. If I file a lawsuit, it will be on a contingency fee basis, and in many cases, I am able to force the insurance company to pay our hourly fees and costs. The insured never has to pay our fees and costs out of pocket.
