“Any occupation” disability insurance claim discussed by a California Disability Lawyer

Most disability insurance policies will contain both an “own occupation” and “any occupation” definition of disability. The own occupation definition is usually only for the first 24 months of disability. After 24 months, the claimant must re-qualify for disability benefits under the any occupation definition. While most claim denials take place during the any occupation period, it is important for a claimant governed by California law to understand how “any occupation” has been defined by the court. Our California disability lawyers have helped thousands of claimants to receive disability insurance benefits during the any occupation stage of a disability claim. Let’s take a look at a case that goes back to 1938.

California Court Discusses “Substantial And Material Duties” In A Disability Policy

In 1938 Mr. Erreca was thrown from a horse, sustaining multiple fractures in his right leg, and tearing several ligaments in his knee. He remained in the hospital for two months, suffered a pulmonary embolism, needed crutches for several weeks, developed varicose veins, developed lesions and ruptured varicose ulcers. At trial he required the use of a cane, but could only walk for short periods of time without his legs swelling. He also had a permanent instability in his knee. Because of his forced inactivity, he gained 40 pounds and suffered from shortness of breath and an increased heart rate.

Mr. Erreca argued that he was totally disabled because he could no longer perform any of the manual labor required of him, nor could he manage or supervise farm operations. Western States Life argued that the Mr. Erreca was not totally disabled because he could do a long list of verbal duties (i.e. negotiations, signing of agreements, talking with employees). However, the court found that “[a]lthough such activities are neither trivial nor inconsequential, they are the type of duties that are infrequently and intermittently performed and cannot be said to constitute the substantial and material duties of the occupation of farming.”

Claimant Must Be Able To Work With “Reasonable Continuity” Or He Or She Is Disabled

The Erreca court also defined total disability in an any occupation policy as being, “a disability which prevents [the insured’s] working with reasonable continuity in his customary occupation or in any other occupation in which he might reasonably be expected to engage in view of his station and physical and mental capacity… such a disability as renders the insured unable to perform the substantial and material acts necessary to the prosecution of a business or occupation in the usual and customary way.” Absolute helplessness is not required; thus an insured’s ability “to perform sporadic tasks, or give attention to simple or inconsequential details incident to the conduct of business” does not preclude recovery. “Conversely, the insured is not totally disabled if he is physically and mentally capable of performing a substantial portion of the work connected with his employment. He is not entitled to benefits because he is rendered unable to transact one or more of the duties incidental to his business.”

The above law has been applied countless times by California courts. If you would like assistance with your disability insurance claim, then please contact us for a free phone consultation.

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Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

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Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

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No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

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When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

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I have worked for AT&T for 41 years and have never had a disability claim. I woke up one morning in severe pain and to make a long story short I was diagnosed with spinal stenosis in my neck. AT&T and Sedgwick Claims Management Services denied my claim until Gregory Dell took over my claim and eventually I was paid for six months after he won my appeal. I was immediately denied again by Sedgwick following an IME exam. Without the help of Gregory Dell and his associates I don’t know what I would have done. AT&T’s claims management company Sedgwick tries to scare you into coming back to work and jeopardize your health. Dell & Schaefer lawyers know what to do and let you concentrate on working on your health problems. I feel lucky to have Gregory fighting for my disability benefits.

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