Long-Term Disability Claims Archives | Scottsdale Personal Injury Blog

Professionals', athletes' long-term disability claims turned down

2017-08-01T17:00:00Z

When professionals, business owners and professional athletes try to make claims against their long-term disability insurance, they are often denied. Many are denied illegitimately and in bad faith. That's illegal.

Insurance companies spend millions on surveillance of potentially expensive claimants. They hire experts to prove that claimants aren't really disabled. They assert that claimants are required to get a job outside their field instead of making a claim on the long-term disability insurance they've paid for all these years -- even though the policy says they don't have to do that.

]]> If this is happening to you, you need an advocate. You need someone with experience disproving insurers' illegitimate claims so you can get the benefits you've paid for.

Long-term disability among attorneys, doctors, other professionals and athletes

Professional athletes have extremely physically demanding jobs with high injury rates. Disabling musculoskeletal and soft tissue injuries can end your career. Brain injuries are increasingly evident. Athletes are smart to get short- and long-term disability insurance, but their claims are often wrongfully denied.

Lawyers and CPAs can suffer a number of physical and mental conditions that negatively affect their ability to concentrate, multitask, or handle stress. All of these are covered by LTD insurance.

Physicians, nurses, dentists and other medical professionals often experience injuries to the back, shoulder, wrists and hands. These can temporarily or permanently end your ability to practice.

When business owners suffer a disabling injury or illness, reimbursement for diminished earnings and business overhead expenses may be provided in your LTD policy.

What is own occupation coverage?

"Own occupation" disability insurance, often referred to as "own occ" is meant to protect professionals with disabling conditions that render them unable to perform the functions of their occupation. It's supposed to keep disabled doctors, for example, from having to prove that they couldn't work a retail job before their disability claims can be paid.

All too often, insurance companies try to wriggle out of paying own occ claims by attempting either to redefine your occupation or the requirements of your occupation. For example, they may tell lawyers that the legal field includes all jobs for which a J.D. degree would be helpful. Or, they may claim that there is some obscure niche job in your field that you could handle despite your disability.

Don't let them. Your own occ long-term disability policy is meant to protect you from these absurd definitions and demands and to pay out when you are unable to perform the material duties of your own occupation.

If your LTD claim has been denied, we encourage you to contact an attorney who can protect your rights and advocate for the swift, full payment of your claim.

Long-term disability insurer writing you off as a bad bargain?

2017-06-30T20:00:00Z

If you're an attorney, a CPA, a medical professional, a professional athlete or a business owner, you may find it surprisingly difficult to get your long-term disability insurance claim paid. It's not because your occupation is especially dangerous, and it's probably not because you've made a mistake filing your claim.

The truth is, many insurance companies deny long-term disability (LTD) claims in bad faith. What does that mean? Often enough, it means they simply refuse to adhere to the terms of the policy, ignore or delay your claim, or fail to reasonably consider the merits of your claim.

]]> It may not be personal. Some companies actively deny claims because their company's underlying financial position is weak and they want to use your money to shore it up. With interest rates down and an aging workforce, their investments aren't making money but their insurance pool is making claims.

One common tactic they use to save money is to short-change you on your claim, rather than trying to get away with not paying it at all. Sure, they'll concede you have a serious injury or illness. Instead of considering the real parameters of your disability, however, they will look at an actuarial table and refuse to pay you any more than the average person in your situation would get.

You aren't some theoretical "average person." You're a person who is suffering a serious and disabling condition that is keeping you from working. Your LTD claim shouldn't be based on an average claim but on your specific treatment needs and expenses.

What if I have an own occupation policy?

Your LTD insurer may tell you that your claim is different because you're in an occupation-based plan -- an own occupation or any occupation plan -- rather than a traditional group plan. They may try to claim you're not disabled because you might be able to perform some work, somewhere.

Again, the insurance company may well concede your disabling condition, but then do the math and claim you are only entitled to benefits for the average recovery time, which they specify. Or, they may try to get you to prove you can't do any work -- but that's not required by own occupation policies.

At Adelman German, PLC, we want your insurance company to do right by you. If they're unwilling to do that and delay or deny your claim in bad faith, we are ready to take them to court. We know all about insurance company practices, and we are not easily intimidated.

Your long-term disability insurer may deny you in bad faith

2017-06-20T18:30:00Z

When you work in an office or clinic, you may have assumed you would never need LTD insurance because your work isn't usually dangerous. Unfortunately, doctors, attorneys, executives, accountants, architects, writers, orthodontists and other professionals are vulnerable to long-term disability.

Consider what it would mean for your career if you lost your vision or hearing. What if you suffered a traumatic brain injury while biking? Your injury does not have to be work-related for a long-term disability policy to apply.

]]> Now you've suffered a disabling illness or injury that will keep you from working for a long time. You bargained and paid for long-term disability insurance when times were good. Now that you need it, will that LTD claim be paid promptly and fully? Will it be paid at all?

Insurance companies make more money when they limit or deny claims

Insurance policies are contracts. You've paid the often costly premiums and, to the best of your knowledge, you've complied with all the terms. Getting your LTD claim paid ought to be easy.

Unfortunately, insurance companies often fail to live up to their end of the bargain. They may refuse to adhere to the terms of their own contract. They may ignore you. They may deny your claim so quickly that they couldn't have fully considered it. They may delay, delay delay. If they do, they could be acting in bad faith -- which means you have to act.

Here are some common examples of bad faith delay or denial of claims:

Simply refusing to pay with no sound reason
Denying your claim without even investigating it
Finding reasons to cause an unwarranted delay in payment
Pressuring you to drop your claim
Using deceptive practices to imply your claim is invalid

Even if you haven't submitted your claim yet, you may want a lawyer

At Adelman German, PLC, we are very familiar with bad faith tactics by insurance companies. If you are just beginning to prepare your claim, we want you to feel comfortable reaching out to us for help and advice so we offer a free initial consultation. To set one up, call 602-635-1401.

We will carefully review your policy, make sure you've complied with the terms, and help you prepare and file your claim properly. We will give the insurance company every reason to pay your claim appropriately.

If your claim has been denied and you believe that was wrongful, Adelman German has extensive experience both in handling LTD claims and in identifying bad faith situations. We are prepared to fight for your rightful benefits and hold the insurance company accountable when they refuse to hold up their end of the bargain.

Do you fear your long-term disability insurer is stalking you?

2017-06-05T20:30:00Z

Have you received a Facebook or LinkedIn friend request from a stranger? Have former co-workers called to let you know they were interviewed about you by an insurance company? Perhaps you've noticed an unusual number of photographers in your neighborhood recently.

Do you suspect your long-term disability insurance company has you under surveillance? If you do, unfortunately, you're probably right. It happens all the time. It's part of the hardball game some insurance companies play.

]]> Their behavior may not meet the legal definition of stalking, but it can feel that way. It may even be intentional: some companies engage in these tactics because they hope you will drop your claim.

Why would a long-term disability insurance company put me under surveillance?

It's extremely common for LTD insurers to use surveillance, and they often put someone on the case right away. The main reason is that LTD claims can cost them a lot of money and they're hoping to prove you aren't as disabled as you claim.

Private investigators and surveillance companies are only too willing to hang around your neighborhood hoping to catch you doing something to limit or invalidate your disability claim. If you have a back injury that keeps you from lifting more than a few pounds, for example, they may take photos or videos of you holding something that appears heavy.

Often enough, they will even troll you on social media. If you've posted pictures of your last family barbeque, the investigator may claim you helped out too much for a disabled person. They're hoping to catch you out.

What should I do if I suspect I'm under surveillance by an insurance company

The truth is, these tactics do work. Disability insurance companies are known to spend hundreds of millions on tactics like surveillance, forensic accountants and so-called medical "experts." They wouldn't spend that time and money if it wasn't getting them the results they want.

Even though you're genuinely unable to work, you need to be aware of how you're presenting yourself. You need to do what is best for you in terms of your health and quality of life, and you should never feel you need to exaggerate or lie. That said, be circumspect about what you show the outside world, whether it's at home, in public, or on social media.

Companies have the right to verify the validity of the claims they pay. When they attempt to harass or intimidate people with legitimate claims, however, they may be acting in bad faith.

If you believe your disability insurance company has unfairly delayed or denied your legitimate claim, a good disability insurance attorney can help you fight back. Don't be intimidated by insurance company tactics. You've suffered enough.

What's the difference between a denied claim and a bad faith denial?

2017-01-11T20:59:04Z

Many valid disability claims are wrongly rejected. Insurance companies can be sued for unreasonable denial or delay.

An insurance policy is a contract. In exchange for paying monthly premiums, the insurer agrees to cover certain losses from whatever you are insured against - fire, flood, collision, long-term disability.

Some people find out the hard way that the specific event is not covered under their policy. Yet many legitimate claims that should be paid are flatly rejected or endlessly delayed for no valid reason. This is illegal. It's called "bad faith denial" or "insurance bad faith." Under Arizona law, insurers can be forced to pay the claim -- plus damages -- for engaging in such practices.

]]> What is insurance bad faith?

Insurance companies cannot deny your claim on a whim or a hunch. They must provide a specific reason such as a policy exclusion or incomplete information. They must offer a process to amend, dispute or appeal your claim. And they must process claims in a reasonable time frame, rather than dragging it out for months and giving you "the run-around" when you ask about the hold-up.

A lawyer who handles insurance litigation can intervene if your claim filed in good faith has been stymied. If the insurer continues to unreasonably withhold your entitled benefits, you could have a possible lawsuit for insurance bad faith:

Denying your claim without conducting a reasonable investigation
Making no good faith attempt at a fair, prompt and equitable settlement
Failing to provide a reasonable explanation of denial based on the policy language or applicable law
Using deceit to force you into a "lowball" settlement

Compensation for a finding of bad faith

To encourage timely payment of valid claims, Arizona statute places a significant burden on insurers found to be acting in bad faith. Plaintiffs may be entitled to:

Payment/settlement of the original claim
Reimbursement of attorney fees
Monetary damages for emotional distress (pain, humiliation and/or inconvenience)
Punitive damages when the conduct is deemed "aggravated, outrageous, malicious or fraudulent"

A claim denied because of bureaucratic bungling can be considered bad faith, but it would not trigger punitive damages. An award of punitive damages requires intentional conduct such as systematically denying certain claims, exploiting an obscure technicality, willfully ignoring valid evidence or stalling claimants with endless requests for "additional information".

Is there a reasonable basis for delay or denial? You and the insurance adjuster may disagree over the interpretation of your policy. But trust your instincts if you think the insurance company is violating the law. Most attorneys who handle insurance disputes offer a free initial consultation and take bad faith lawsuits on a contingency fee (no legal fees unless they win compensation).