1.Can you work
in a different occupation while collecting disability
income payments?
2.Do you need to suffer a loss of income to collect
disability income payments?
3.What are the remedies if the insurance company denies
your claim?
4.How severe must a disability be in order to collect
under your policy?
5.If denied, will the insurance company pay your attorney
fees?
-Other
Issues to Discuss with Dell & Schaefer
1.Can you work
in a different occupation while collecting disability
income payments?
Yes, if your policy has an “own occupation” definition
of disability, you can work in a different occupation
while collecting disability income benefits. However,
the duties of your new occupation must be substantially
and materially different.
2.Do you need to suffer a loss of income to collect
disability income payments?
Under many policies if you are unable to perform
the substantial and material duties of your occupation,
then you do not need to suffer a loss of income in
order to collect total disability benefits. Under
many of these same policies, if you are only residually
disabled, as opposed to totally disabled, then you
must generally suffer a percentage loss of pre-disability
income as defined by the policy.
3.What are the remedies if the insurance company
denies your claim?
Most disability income policies
have an internal appeals process when an adverse
decision has been
made on your claim. In the event an appeal determination
has been unfavorable to you, or no such clause exists
in your policy, you may proceed to the appropriate
court having jurisdiction of your claim. Be aware,
that most policies have time limits, which govern
when a legal proceeding, may be commenced or prosecuted.
In addition to the litigation process, many States,
upon proper request, will investigate through their
department of insurance an insurance carrier’s
claim denial.
4.How severe must a disability be in order to collect
under your policy?
The severity of your disability in relation to your
ability to collect benefits is dependant upon whether
your policy contains an “own occupation” definition
of disability. If it does, you can generally collect
total disability benefits if your disability prevents
you from performing the substantial and material
duties of your occupation. You may wish to continue
in your present occupation with a change of duties
or switch occupations.
5.If denied, will the insurance company pay your
attorney fees?
In many instances, the insurance carrier may pay
all or part of your attorney’s fees if a denial
of benefits is determined to be wrongful by a court
of competent jurisdiction. Many States have statutes
that require an insurance carrier to pay a claimant’s
attorney’s fees following the successful pursuit
of first party benefits. In addition, there are state
statutes that authorize punitive damages for bad
faith denial of claims for disability benefits.
OTHER ISSUES TO DISCUSS WITH
DELL & SCHAEFER
1.When must I file my claim?
2. What role does my physician play in my claim for
disability?
3. Must I disclose all of my financial information?
4. What is total disability vs. residual disability?
5. Should I give an interview or statement to the
disability income carrier?
6. How much information should I give my disability
income carrier?
7. How much time should the carrier have to investigate
8. Can I collect benefits while the carrier is investigating
my claim?
9. Can I collect social security benefits or workman's
compensation while collecting disability
income benefits?
10. What if I disagree with the claim decision made
by my carrier?
11. What is the disability income carrier's internal
appeal procedure?
12. In the event of a denial by my disability income
carrier, how does the litigation process work?
13. How are attorney's fees charged?
14. Under what circumstances will my disability income
carrier pay my attorney's fees?
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