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How Does the Accident vs. Sickness Provision Affect Your Claim?

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 benefit.

Disability insurance lawyers Cesar Gavidia and Gregory Dell discuss the importance of addressing and identifying a potential accident v. sickness issue as soon as possible. We have litigated and appealed this issue on numerous occasions and have been successful in proving that a disability was caused by an accident and not a sickness. Contact us for a free consultation to discuss your disability claim.

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Disability Company Reviews

(668)

Showing 8 of 668 Reviews

Mutual of Omaha

90 days and still waiting

Reviewed by Cheryl on July 26th 2025 Verified Policyholder | July 2024 date of disability

I filed for benefits in July, 2024 with an effective date of 7/30 (after the 14 day wait) and today is October 18th and my claim is still pending. They either don't want t... read more >

New York Life

NY Life Short Term Disability Team is Terrible

Reviewed by Dr. T on July 22nd 2025 Verified Policyholder | August 2024 date of disability

I am a physician and was in a high velocity rear impact car accident. The person slammed into my stopped car going almost 50mph. Was not physically or cognitively able to ... read more >

Sedgwick

Sedgwick will use the false need for discovery to deny your claim

Reviewed by Calvin on July 20th 2025 Verified Policyholder | August 2021 date of disability

Sedgwick will use the false need for discovery to deny your claim for as long as possible to wear you down because you are out of work and need the money.Lie, cheat and ... read more >

Unum

Unum does not act as a fiduciary

Reviewed by Unum is horrible on July 15th 2025 Verified Policyholder | October 2025 date of disability

I received paycheck from 2 sources at work. I was approved for LTD by Metlife within 40 days, no questions asked. I was approved by NWM which was my private own occupation... read more >

Unum

UNUM denied my LTD claim after 6 months although my health continues to decline

Reviewed by Michael B on July 12th 2025 Verified Policyholder | July 2023 date of disability

An attorney is needed to monitor an open, ongoing claim. I naively thought payments would continue. Review of medical records by a disability attorney before submission to... read more >

MetLife

Horrible STD Service. Run !!!!

Reviewed by Scott F. on July 8th 2025 Verified Policyholder | June 2025 date of disability

For the first time since I can remember my employer did not offer STD as one of my paid benefits so I’m paying for this policy. Had to file a claim on 6-14-25. Went thro... read more >

Reliance Standard

Reliance Standard cut off LTD suddenly claiming I could do sedentary work after 10 plus years… no paperwork sent to appeal

Reviewed by Autumn on July 1st 2025 Verified Policyholder | January 2015 date of disability

I’ve been on STD then LTD with Reliance since 1/2015. They sent a medical review in December 2024 to my old address which of course I never got the paperwork for. I emai... read more >

Sedgwick

Denial for benefits, Sedgwick is the worst

Reviewed by Andrea on May 22nd 2025 Verified Policyholder | June 2024 date of disability

I was not paid for 7 months on STD. My appeal was finally approved, but in the meantime I lost company match on my 401k, and then they canceled my company insurance. Out o... read more >

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Disability Benefit Tips

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Why Must Your Disability Insurance Lawyer Understand Your Disabling Condition?

When it comes to securing your disability insurance benefits, it's vitally important that your disability insurance lawyer thoroughly understands the symptoms and impact of your disabling condition. Doctors can help you create strong medical records, but they're not accustomed to dealing with the rigorous documentation disability insurance companies require. Lea... Read More >

Disability Benefit Denial Reason #5 – Your Medical Evidence is Weak

If you're seeking long term disability benefits from an insurance company, you may be concerned that you're facing an uphill battle. Fortunately, the stronger your medical evidence, the greater the odds that your claim will be approved. On the other side of the coin, one of the most common reasons for denial of long term disability benefits involves too-weak med... Read More >

Disability Benefit Denial Reason #4 - Your Doctor Is Misled By the Disability Company

When you're seeking disability insurance benefits, your medical records and treating physician's statement are two of the most important components of your claim. But because the insurance company has a vested interest in denying your disability insurance claim, it often will rely on tactics like ambushing your doctor with a phone call in an attempt to get them ... Read More >

Disability Benefit Denial Reason #3 - Video & Social Media Surveillance

One thing many disability insurance claimants don't know about (or expect) from the claims review process involves video and social media surveillance. Disability insurance carriers often hire people to follow claimants around with a telephoto lens - or even send social media friend requests from fake accounts - to glean whatever information they can about the c... Read More >

How Do You Fight a Long-Term Disability Denial?

Getting a denial letter from your disability insurance company is one of the ultimate insults. You are sick and not able to work, yet your disability insurance company is telling you to return to work. The disability insurance company has denied your disability benefit claim and is basically calling you a liar. When receiving a disability denial letter or a ph... Read More >

Disability Denial Reason #2 - Change of Disability Definition & Vocational Review

One of the top reasons for terminating a claimant's long term disability benefits involves the change in the disability insurance policy's definition of "disability." This definition change often happens in conjunction with a vocational review, or an analysis of a claimant's medical records that tells the insurance company which jobs the claimant should be able ... Read More >

Disability Denial Reason #1 – Paper Review & IME

At Dell Disability Lawyers, we've seen insurance companies give countless reasons to deny long term disability benefits. However, most disability benefit denials tend to fall into one of a few categories - and one of the biggest ones is the paper review and independent medical exam (IME). Learn more about what this review process entails and what your claim file... Read More >

How to Apply for Reliance Standard Disability Benefits & Top 5 Reasons for a Claim Denial

At Dell Disability Lawyers we’ve handled hundreds of long term disability insurance claims against Reliance Standard, and have learned a few things in the process. When you’re experiencing an injury or illness that makes it difficult (or impossible) to work, it can be tempting to file a claim as quickly as possible – but unless a claimant has all their ducks in a row, this could actually delay the ultima... Read More >

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Dell Disability Cases

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Showing 8 of 374 Dell Disability Cases

Seven Surgeries and The Standard Still Denies Disability Insurance Benefits

Our client was employed with the State of Oregon as a Technical Support Representative. She sought disability through her employer provider LTD Policy with Standard due to low back, hip, and lower extremity pain. She had two hip, two knee and three back surgeries.After paying her for 1.5 years Standard hired a board-certified neurologist to perform a review ... Read More >

Sun Life Wrongfully Denies Disability After Paying For 23 Months

We represent a 57 year-old claimant who’s occupation was selling commercial vehicles for many years. Her job was very physical as it required her to climb in and out of semi-trucks multiple times a day as well as operate them which was very strenuous. She went out of work in due to ongoing and severe debilitating right hip, low back, and bilateral knee pain... Read More >

Nurse Denied Long-term Disability Benefits by Lincoln After the Definition of Disability Changed

Our client, a registered nurse for Dignity Health, found herself in a difficult situation after being diagnosed with lumbar spondylosis and left knee arthritis. She continued to work, however, struggled while attempting to work through chronic lower back pain and left lower extremity radicular symptoms on a daily basis. Sadly, her condition failed to improve and... Read More >

Lincoln Reverses Decision to Terminate LTD Benefits of Corporate Attorney after Dell Disability Lawyers Appeals the Decision

The claimant is an 64 year old former Corporate Attorney and at a prominent Florida business law firm who was forced to cease working in his highly successful and rewarding profession, job, and career on January 27, 2021, and to seek disability compensation under his policies with Lincoln due to severe symptomatology stemming from or following a viral COVID-19 i... Read More >

Transportation Manager with Brain Injury Wins Unum Disability Benefit Appeal

Unum unjustly terminated our client’s disability insurance claim after it had approved and accepted liability for six months. Unum unreasonably concluded, without any evidence of improvement, that the claimant had resumed the sustained work capacity to perform the material and substantial duties of her high level occupation as a Transportation Division Manage... Read More >

Prudential reverses decision to terminate LTD benefits of MRI Tech with Primary Progressive Multiple Sclerosis and degenerative Disc Disease

The claimant is a 58-year-old former MRI Technologist for Fairview Health Services who has long suffered from the debilitating effects of her chronic medical conditions. She has a history of neck pain as well as right arm pain and numbness dating back to 2005 with a reoccurrence of severe symptomatology in 2013. MRI of her cervical spine performed in August of ... Read More >

Engineer With Depression Wins Prudential LTD Appeal

The claimant is a former Senior Technology Services Engineer for Accolade, Inc. who was forced to cease working on May 25, 2021 and to apply for disability insurance benefits under his policy with Prudential because of severe symptomatology related to depression and anxiety. Prudential initially approved his claim for LTD benefits as his symptoms were demonstrat... Read More >

New York Life Approves Disability Benefits for School Teacher With Multiple Sclerosis

Our client, a former elementary school teacher suffering from Multiple Sclerosis, contacted our office after New York Life terminated her claim for short term disability benefits and spoke with Attorney Stephen Jessup. New York Life had initially approved her claim for short term disability benefits, but in doing so awarded benefits only on account of a mental health condition, even though our client had filed... Read More >

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Disability Lawsuit Stories

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Showing 8 of 765 Lawsuit Stories

Reliance Standard Disability Denial Upheld Due to Claimant's Lack of Strong Medical Record Support

In the case of Amy Wright v. Reliance Standard Life Insurance Company (Reliance), Plaintiff was the vice-president of health information services at Integrity Health Care when she stopped working on August 7, 2017. She brought claims for benefits under an LTD insurance policy and a waiver of premiums under a life insurance policy.In order to be approved for LTD benefits, Plaintiff ... Read More >

Unum Wrongfully Terminated Disabled Lawyer’s Disability Claim of Depression and Anxiety Despite Improvement in His Condition

This Unum lawsuit and appeal in federal court is a great victory for all Unum disability claimants. This case supports all claimants that are disabled and claim that they cannot return to work as the requirements of their job will aggravate their symptoms and make them unable to work.Mark was a personal injury litigation attorney, when he began struggling with symptoms of... Read More >

Federal Court Overturns Aetna Denial Of Disability Benefits

In the recent case of Ferrin v. Aetna Life Ins. Co. a federal judge from the Northern District of Illinois determined that Aetna improperly terminated Ferrin’s claim for long term disability benefits and ordered Aetna to reinstate Ferrin’s claim and pay all past due benefits with interest. Prior to filing for long term disability Ferrin was an employee of Southwest Airlines. In 2008, while at work, she suf... Read More >

Court Finds Irregularities in Procter & Gamble Disability Insurance Benefit Denial

In ERISA cases filed in a district court asking for judicial review of a plan administrator's denial of benefits, the court is generally limited to considering only the administrative record that was before the plan administrator. The case of Robert Stallings v. The Proctor & Gamble Disability, Committee, et al., is an example of how plaintiffs with cases filed in a District Court that is under the jurisdi... Read More >

Federal Judge Makes Companion Life Insurance Pay Disability Benefits

Companion Life tried to play games and deny disability insurance benefits, but thankfully a New Mexico Federal Judge made them pay disability benefits and attorney fees. The Plaintiff, Mr. Paul Chandhok, was recently awarded disability benefits in a decision by The United States District Court for the District of New Mexico, in a case decided on August 13, 2021. What makes this decision important for plaintif... Read More >

NFL Disability Review Board Ignores Evidence of Disability and Appeal Court Reverses Lower Court Decision

In Darren Mickell v. Bert Bell/Pete Rozelle NFL Players Retirement Plan (Plan), Mickell spent nine years in the NFL as a defensive end. He was repeatedly subjected to high speed contact hits which caused multiple orthopedic injuries to his “back, ribs, shoulders, arms, hands, knees, hips, legs, and feet." He had multiple orthopedic surgeries. Mickell also sustained multiple blows to his head t... Read More >

Judge Agrees that MetLife's Denial of Long Term Disability Benefits was Reasonable

In Anne Ehlert v. Metropolitan Life Insurance Company (MetLife), Ehlert was a consulting pension actuary for pension plans at Towers Watson. Her first day of work with Towers was September 8, 2003. Her last day of work was December 23, 2015. In August 2016, she applied for long-term disability (LTD) benefits under her employer’s disability insurance benefit plan which was administered by MetLife.In thi... Read More >

Can Standard Insurance Company’s Failure to Raise an Issue be Considered a Waiver?

The case of Jose Chavez v. Standard Insurance Company has quite a history with the United States District Court for the Northern District of Texas, Dallas Division. It began in September 2016 when Standard first began paying long-term disability benefits to Chavez. He had several operations on his wrist and was no longer able to perform the duties of his own occupation.Standard terminated his ben... Read More >

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Reviews from Our Clients

Keith G.

They were very professional with their responds and on time with keeping you inform about everything with your case. I would recommend My lawyer Stephen Jessup, he was on point with everything, thank you. You guys are awesome people to work with. God bless you guys.

Keith L.

I was not able to work as a physician for about 14 months due to neck/back issues. Even though I had 3 medical doctors explicitly state that I was not to work AT ALL as a physician at that time, New York Life (NYL) Disability Insurance denied my long term disability claim (which apparently they deny a high percentage of people similar to me- only they know why they do this to so many- I have my own suspicions). I was in pain from my medical issues and so frustrated with NYL considering I had many bills coming due. I then decided to call Dell Disability Lawyers. One of their attorneys, Alex Palamara, spoke to me on the phone right then to hear and understand my story and then offer ways he could help. Long story short, within a few months of me returning back to work, he was able to persuade NYL to pay me my long term disability claim. He (and his kind assistant, Tabitha) were always very helpful, informative, and available to me. I feel quite certain that NYL would NEVER have paid me what was appropriate based on my insurance agreement/ contract with them without the help of Alex. I highly recommend him/Dell Disability Lawyers. If you find yourself in a similar situation of disability insurance denial of your own personal/group policy, especially if you are a medical provider/physician like me, then consider contacting them for advice/direction PRIOR to appealing your claim on your own.

Kyle D.

Jay Symonds and his assistant, Sonia helped me tremendously. The insurance company that worked for my former employer did everything they could to make my life literally miserable. That all changed when I hired Jay. He and Sonia fought for my rights and forced the insurance company to pay what they should have.

If you have a disability claim hire Jay as if you go it alone the insurance company will screw you. Jay and Sonia will fight for everything you are entitled for. I couldn’t recommend them more highly.

Frank R.

I cannot say enough positive things about my experience with Dell Disability Lawyers. Attorney Stephen Jessup and Amanda offered an opportunity to provide clarity on a complex issue regarding my disability claim. Mr. Jessup offered advice on an offset to my claim after my insurance company asked for additional information from Social Security. With counsel from Mr. Jessup, I was able to address the outstanding issue with the Social Security office and provide my insurance company with the required documentation to address their concerns. Mr. Jessup always responded in a timely manner with expert advice and offered the opportunity for follow up. I strongly recommend Dell Disability Lawyers to those seeking legal counsel for disability matters.

Wesley D.

I have been able to help others as a soldier, a police officer, and a pharmacist. I needed help forcing the insurance company to keep their commitment to take care of me and my family. I called Dell. Alex, Tabitha, and their entire team were very compassionate, extremely patient, and extraordinarily knowledgeable. Many thanks Dell!

Samar A.

My husband had applied for Long Term Disability and was denied. We sought out Rachel Alters at Dell Disability Lawyers to help us with our appeal. Rachel and her team were so diligent and meticulous in every aspect of the process. The process was seamless, and we never had any doubts that she would get it done and that she did! We are forever grateful to Rachel and Catherine for all of their determination and tenacity to get us the outcome we needed and deserved.

We could not recommend better representation and are indebted to them for making us whole again. Thank you so much Rachel and team!

Jam

Alex Palamara is one of The Best lawyers in the world and Dell Disability Lawyers are the Best by Far. Alex and his Assistant Tabitha helped me get the compensation I needed for a Horrific Disabling heath condition I’ve been dealing with for over a year. Alex and his team were so professional and caring. They treated me like I was there own family. Alex Knowledge, Expertise and skills as a Lawyer is among the Best of the Best in his field and I would HIGHLY recommend that if you ever have any issues with any Insurance Company over your Disability issues, please don’t hesitate to seek out Dell Disability and Alex Palamara. They truly are Amazing and caring. Thank God for them. Outstanding Job Alex and Tabitha

G.T.

9 years ago when I had to apply for disability benefits from my private disability policy the insurance company ignored my inquiries until Dell and Schaefer represented me and I have received the benefits without interruption til my policy expired at age 65. I have appreciated not having to deal directly with the insurance company and having attorney Greg Dell and assistant Danielle Lauria handle all communications which included monthly progress reports. I thank them for their efforts on my behalf and highly recommend them to all those in need of disability benefits.

Misty A.

I’m so thankful I chose to reach out to the attorneys at Dell. They have always been quick to respond to any and all questions I have had. The anxiety I had while dealing with Lincoln Financial on my own has decreased immensely since Alex and Danielle took my case. They were able to get my LTD denial reversed and I am so very grateful!

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