Disability Claimants Must Make Reasonable Attempts to Recover

The General Duty to Mitigate

Throughout the country, insurance policyholders — including those who have a disability insurance claim — are expected to adhere to a “duty to mitigate.”  This duty to mitigate requires that the policyholder make reasonable efforts to minimize their various losses in the wake of a disability.

Consider the following.

Imagine that you have been injured in a motor vehicle accident.  As a result of your injuries, you are rendered disabled.  According to terms of your private insurance contract, you qualify for disability benefits.  However, after an initial consultation with medical professionals, you do not follow-through on treatment.  Your disability becomes more severe.  Your insurer denies your claim for disability benefits, citing the fact that you have not properly mitigated your various losses.

The duty to mitigate demands reasonable efforts.  What constitutes reasonable efforts varies depending on the circumstances.  As a general rule, however, the policyholder must follow the advice of treating medical professionals and be consistent in rehabilitating their disabling condition.  If you skip physical therapy sessions for several months, for example, then the insurer will almost certainly use that information as a basis to deny your benefits claim.

In real-world circumstances, it is unlikely that an insurer will deny a claim for “failure to mitigate” unless there is a clear and significant issue involved.  Minor problems — one or two skipped sessions, or a slight delay in making a medical appointment — will usually not lead to a mitigation-based denial.  If your insurer denies your legitimate disability claim on such basis, then you may be entitled to bring a bad faith claim against them.