What is the discretionary clause in a disability insurance policy?

The discretionary clause is a contractual term in a disability insurance policy that provide insurers with sole discretion in deciding if, when, and what benefits are due under the insurance policy.

These clauses are only detrimental to a claimant if the policy is governed by ERISA. An example of a discretionary clause in a disability policy would state, “The administrator (insurance company) has sole discretionary and authority to determine eligibility for benefits or to interpret the terms or provisions of the policy or contract.

The existence of a discretionary clause limits the way that a Court can review a disability claim denial and makes it extremely difficult for a court to conduct a fair review of a disability claim.

More than 12 different states have enacted laws that prohibit disability insurance companies from selling disability policies that contain a discretionary clause. The National Association of Insurance Commissioners model rules propose the abolishment of all discretionary clauses.

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FAQ

Do you work in my state?

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.

What are your fees?

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.

Do I have to come to your office to work with your law firm?

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.

How can I contact you?

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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Jane F.

When I called Dell & Schaefer I felt hopeless. When I called, a phone conference was immediately set with an attorney, Rachel Alters. The attorney listened carefully to my story, and my concerns. She was thoughtful even as I had difficulty holding back my tears and maintaining my composure. I sent several documents via e-mail and fax and she returned my call within a very reasonable amount of time. I was so grateful when she agreed to take the case.

The attorney had an assistant that was also helpful. I felt very well advised and confident that Dell & Schaefer and my attorney were on my side. I was also relieved to know that once I sent the information to the firm that my work, such as reviewing and completing paper work, or calling doctors for further documents, was mostly finished. They took the reigns. I didn’t have to try and keep fighting all by myself. I was already exhausted by my disability and the legal fight was making my life even more miserable. After what seemed like a long time, although only six short months, Rachel called to tell me that she had a settlement offer from the insurance company that had denied any benefits to me for over 2 years. Rachel and each staff member treated me with respect and understanding. I am very grateful for their help and so grateful that a firm exists that can fight against these big insurance companies and win.

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