BRYANT LEGAL GROUP

Types of Short & Long Term Disabilities Covered

Short and long term disability coverage can vary quite significantly, and in fact, often differ to such a degree that insured disability claimants who qualify for benefits under one plan may be denied benefits under another plan.

Disability policyholders may be confused or even surprised by the possibility that their claim will “fall through the cracks,” so to speak. After all — to the average person — if one is severely injured or suffering from a condition that seriously impacts their ability to work, then their qualification for disability benefits seems obvious.

Insurers frequently take advantage of the fact that disability policyholders might not fully understand their policies, and that, as a general rule, disabling conditions put the claimant in a vulnerable position — when the policyholder has been disabled, they are likely more concerned with their recovery (and with integrating themselves into their normal life) than with the administrative hassle of securing benefits. Insurers understand this natural tendency and are more likely to deny or delay the processing of a legitimate disability insurance claim so as to discourage the policyholder from taking steps to obtain their rightful benefits.

At Bryant Legal Group, P.C., we encourage those who are involved in a dispute with their insurer to get in touch as soon as possible.

Our experienced Chicago disability attorneys can assist you in bringing a dispute against the insurer to secure the benefits that you’re owed.

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I can’t thank David and Jennifer enough for going the extra mile to get Guardian to pay my claim, regardless of the fact that my type of claim, although very legitimate, was difficult to gain coverage. They are my heroes for not giving up. I’m very thankful for both of them and their staff.

- Charles S.

Automatic Qualification for Disability Benefits

Disability insurance carriers generally look for ways to exclude your condition from qualifying as a disability or to otherwise minimize your benefits entitlement. In rare cases, however, you can avoid the complicated calculus that surrounds the typical disability determination — more specifically, if your disability insurance policy includes a list of conditions that automatically qualify as a “disability.”

What conditions qualify automatically as a disability? In private insurance policies, the language and terms of the insurance contract can vary wildly — you’ll, therefore, want to evaluate the specifics of your insurance contract itself with the aid of an experienced Chicago disability attorney.

Still, despite the fact that insurance policies are quite variable when it comes to defining what constitutes a disabling condition, there are some commonalities that you might encounter. In the automatic qualification context, the following conditions are often listed in insurance policies as “disabling” (without further need to demonstrate the extent, nature, or impact of the impairment):

  • Total blindness
  • Total deafness
  • Amputation of limbs

If you are suffering from a condition that qualifies automatically as a disability under your insurance plan, it’s important to note that you may still find yourself at the center of a dispute with your insurer — after all, the insurer may argue that your condition is “not quite” the same as the one that would automatically qualify for disability benefits.

For example, if you are suffering from hearing loss, the insurer may argue that it is not “total hearing loss” and as a result, insufficient to qualify for automatic disability benefits. In such cases, you can introduce supportive medical record evidence and the testimony of treating healthcare professionals.

Disability Coverage Varies Depending on the Language of the Insurance Policy

If you do not qualify for disability benefits automatically, then your condition will be evaluated pursuant to the disability definition established in the insurance contract itself. Policies vary considerably, but the disability definition issue is generally split along one major fault line: own occupation and any occupation.

Disability insurance policies which feature an “own occupation” definition of disability requires that the claimant demonstrate that their particular injury, illness, or condition renders them incapable of performing the duties of their own occupation.

For example, if you are a lawyer for a large law firm, then your neurological condition may make it impossible for you to work in your own occupation and you should be entitled to benefits under your individual disability policy. The “own occupation” definition is less strict than the alternative “any occupation” definition.

Disability insurance policies that feature an “any occupation” definition of disability requires that the claimant demonstrate that their particular injury, illness, or condition renders them incapable of performing any job duties, for any alternative occupation that they would otherwise be qualified to handle.

For instance, if you are a dentist, but you have some experience doing administrative work, then your spinal condition may make your current occupation impossible, but may still allow you to take on office work. Under an “any occupation” of disability, you may not be entitled to benefits.

Importantly, the “any occupation” definition does not require you to show that you cannot perform any job on the market — usually, only those that you would be qualified to work. If you do not have a college degree, for example, the insurer cannot reasonably argue that you could find alternative work as a management consultant.

Mental Health Conditions

Remember, plans vary. Mental health conditions are generally covered by most long-term disability policies, though limitations are often in place to prevent lifetime recovery — for example, the “mental or nervous condition” limitation may prevent you from obtaining benefits for more than two or three years. Contact our Chicago disability attorneys if you have questions or concern in this regard.

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Wrongful Denials and Insurer Strategies

In general, insurers, whether in the context of life insurance, disability insurance, or health insurance, employ strategies to avoid having to pay out benefits, even when the claim seems (upon first impression) to be legitimate. This is a common problem, especially in situations involving a significant amount of potential benefits, such as a life insurance payout or a disability insurance payout where the insured is a high-earning professional.

Strategically, if the insurer can impose a significant enough hardship on the insured or claimant, then some portion of policyholders may simply resign themselves to the adverse determination of their insurer. For example, if an insurer grants you only partial disability benefits, they may do so in the hopes that you will not have the willingness or funds to challenge their decision and thereby secure full disability benefits.

Insurers understand that you may be put in a vulnerable position after a claim denial or undervaluation and they engage with insureds with this power dynamic in mind. It’s therefore critical that you consult with qualified insurance lawyers in Chicago who can advocate aggressively on your behalf and communicate your willingness to fight for the benefits that you’re owed.

Of course, insurers are not legally allowed to simply deny a claim or make any other adverse determination without some “reasonable basis” to do so. For example, an insurer may argue that there is insufficient evidence to support your claim for disability benefits, as it’s not clear whether your condition actually prevents you from working in “any occupation.” Even if the facts tend to support your arguments, so long as the insurer can argue that there is room for a reasonable dispute, then they will likely have no problem denying the award of benefits to gain a strategic advantage.

Insurers are required to adhere to a duty of good faith with respect to their insureds. In non-ERISA plans, if the insurer violates their duty of good faith (perhaps by unreasonably delaying the processing of your benefits), then you may have an actionable bad faith claim against the insurer if you purchased your policy in a state where there is bad faith law. If there is evidence of bad faith, you’ll almost certainly want to litigate the claim. Bad faith claims can give rise to significant damage awards, including punitive damages (which multiply the compensatory damage total).

If you have a complex insurance dispute that involves bad faith claims and the wrongful denial of benefits, we encourage you to get in touch with a qualified Chicago insurance law firm for assistance. Firms with specialized insurance dispute experience, such as Bryant Legal Group, are capable of effectively navigating these complex disputes on your behalf.

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Contact a Chicago Insurance Lawyer at Bryant Legal Group Today

If you have questions about an insurance policy or need assistance with the submission or appeal of an insurance claim, Bryant Legal Group is here to help. By consulting with one of the experienced Chicago insurance attorneys at our firm, you will be given salient advice and legal guidance on all aspects of the insurance contract, from evaluating new policies to applying for benefits to appealing and litigating claims. Insureds are our only priority, which means that whether we are negotiating a settlement with the insurance carrier, challenging a denial, or taking a dispute to court, you can trust that we will do everything in our power to get you the results you are looking for.

Call an experienced Chicago insurance lawyer at our firm today at (312) 313-6179 or complete our online form so that we can find the solution that best fits your needs and expectations.

The content provided here is for informational purposes only and should not be construed as legal advice on any subject.

Contact Bryant Legal Group

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

Request Your Free Consultation

Get the answers and insight you deserve. Our experienced disability insurance lawyers can evaluate your claim and help you understand all your legal options.

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