Disability Policy Language

• What is a “Gainful Occupation” under a Disability Insurance Policy? 0 

  The overwhelming majority of employer provided group long term disability insurance policies governed by ERISA contain two definitions of disability depending on what stage your claim is in. As discussed in depth throughout our website the two definitions of disability are what are commonly known as the “Own Occupation” and “Any... continue

• If I Have Physical and Mental Disabling Conditions Will My Disability Benefit Be Subject to a Limited Pay Period? 2 

  The answer to this question is very fact specific in each case. Not every disability policy has a limited pay period for a mental condition. Most employer provided long term disability policies will limit mental health disabilities to either 12 or 24 months. In the situation where a claimant has both physical and mental disabilities, then it... continue

• Total v. Residually Disability Benefits: The Ongoing Battle? 0 

  The single most litigated issue in a long term disability claim is whether a claimant is residually or totally disabled. Disability companies will save a lot of money if they can prove that a claimant is residual rather than totally disabled. In this video, disability insurance attorneys Cesar Gavidia and Gregory Dell discuss some examples of... continue

• Does the Mental Nervous Disorder Limitation in an ERISA Long Term Disability Plan Violate ADA Laws? 0 

  According to several Federal district courts throughout the country the answer to this question has historically been that the American with Disability Act (ADA) laws does not apply to an ERISA long term disability policy provided by an Employer. The reason the ADA has been found not to apply is because of a concept called ERISA Preemption. ERISA... continue

• Since my policy contains a Waiver of Premium While Disabled Provision, should I still pay the premium for my long-term disability insurance policy while my long-term disability claim is under review? 0 

  Many individual and group disability insurance policies contain Waiver of Premium provisions that allow for the waiver of the annual premiums while you are disabled. However, if your claim is pending and under review, you should continue to make all premium payments which become due until the long-term disability insurance carrier informs you that... continue

• Can I live outside of the United States and collect long-term disability insurance benefits under my individual or group long-term disability insurance policy? 4 

  Answer: Like most answers to questions regarding long-term disability insurance the answer is predicated on the terms and conditions of the long-term disability insurance policy in question. Foreign residency limitations will serve to either deny coverage and preclude payment of long-term disability benefits if the insured resides outside of... continue

• Does A Letter From A Disability Insurance Company Misstating Policy Language Modify The Terms Of A Disability Insurance Policy? 0 

  Occasionally, the issue arises of a disability insurance company misstating the terms and coverage of a disability insurance policy, either verbally or in written correspondence. Most of the time the misstatement is a simple mistake, and due to the claim specialist failing to proofread their letter. Sometimes the misstatement is made on a mistaken... continue

• How does a disability insurance company determine my Regular Occupation? 0 

  The overwhelming majority of employer provided ERISA group disability policies provide disability benefits for a certain period of time if you are unable to perform the material and substantial (or similar language) duties of your "own" or "regular" occupation. Although the semantics may differ from policy to policy, under the own/regular... continue

• Are all LTD claimants considered for alternative professions as part of the “any occupation” investigation? 2 

  A visitor to our website recently posted this question: Are all LTD claimants systematically considered for alternative professions by the various disability insurers as part of the "any occupation" investigation? I especially wonder if older workers might get a bye after a certain age. The evaluation during an Any Occupation depends on the... continue

• Is It Unusual for a Disability Insurance Company to Request an Attending Physician Statement (APS) Once a Year? 0 

  Disability insurance companies require disability claimants to prove that they are disabled. All disability companies require claimants to have their treating physician(s) to complete an Attending Physician Statement Form (APS). Some disability companies require the APS to complete monthly while others require the form every two, three, six, or... continue

• Are There Exceptions to the Mental Illness Limitation in a Disability Insurance Policy? 11 

  Every year thousands of long term disability insurance claimants have their disability insurance claim limited to a specific payment period due to a Mental Illness limitation provision in their disability policy. On a daily basis our disability attorneys handle cases in which we try to get claimants paid beyond the limitation period. We recently... continue

• How will I know if my Long Term Disability Policy contains a limited pay period for physical or mental disabilities and is there any way to get around these limitations? 2 

  Self reported symptoms limitation It is common practice for disability insurance companies to find ways to limit the amout of money they have to pay to claimaints. One of the ways they attempt to limit their exposure is to add limitations into their policies that require the claimant to provide "objective evidence" to prove they have certain... continue

• What is the Accident v. Sickness provision in my disability insurance policy? 0 

  Accident v. Sickness provisions in a disability policy usually becomes an issue when a person is expecting to receive a lifetime disability benefit. This issue only appears in private disability insurance policies. In some policies, if a person becomes disabled due to an accident before age 60, then the claimant may be entitled to a lifetime... continue

• What should I expect if I apply for residual disability insurance benefits? 0 

  July 2, 2012 — In this video, our disability attorneys touch on common residual disability issues and requesta that a disability carrier will have if you are seeking residual disability benefits. Residual disability can be a complicated analysis and it is often misused by disability companies as a substitute for a total disability claim. A carrier may tell a... continue

• What should I be aware of if I am buying a disability insurance policy? 7 

  It is important to take into consideration that every disability income policy may have different features. The following checklist will help you compare your current policies or one you may be considering: How is disability defined? Inability to perform your own job? Inability to perform any job? Does the policy cover accidents?... continue