How can one disability company approve my claim but my other disability company has denied my claim?

Disability Insurance Attorney Stephen Jessup discusses the situation where a disability claimant with multiple disability policies has the claim approved by one disability company but denied by a different company. It is a common occurence where a claimant may have multiple individual disability insurance policies or a group disability policy and an individual policy. The disability insurance companies and social security are not obligated to agree with each others opinions.

I’m getting more calls lately about whether or not when a person has an individual policy they purchased from an agent and a group policy that they were provided through their employer. We see this with a lot with professionals, doctors, lawyers, businessmen more and more. And a common question is, “Well, if I apply on my individual policy and I’m approved, does that mean that the group policy will approve me for benefits or vice versa?” It’s almost the same argument, “If I’m approved for Social Security, will I automatically get my long-term disability benefits,” whatever the policy may be. And the answer is no, not necessarily. Each one of the carriers is going to provide their own review of the claim. There’s a chance more likely than not that they will speak with each other, but each policy will have different definitions as to which disability is, what you’re able to do under the policy, whether it is residual disability.

As we’ve discussed in other segments, if you think of disability policies as cars, a group policy is like a base-model car; it’s not going to have a lot of frills, where an individual policy, you have the ability to buy options that make it more beneficial language-wise for you. So just because your individual policy may approve you does not necessarily mean that your group policy will. I’ve had on more than one occasion and I’m going through it right now recently with a carrier where I had a doctor who was approved on this long-term individual policy denied on the group disability policy. So it’s very important to consult with an attorney when making application for those benefits only because certain things are going to have to coexist and know how to work within the definitions of the policy in which we may be able to do.

So if you have any questions regarding applying for benefits under an individual or group, and especially both, feel free to give us a call.