A Successful California Disability Insurance Claim Does Not Require "Absolute Helplessness"
One of the most hotly disputed areas among California disability lawyers focuses on the definition of “total disability” in private long-term disability insurance policies. An insurance company will routinely deny coverage, relying on policy language that, in its view, requires that the employee not only suffer from a disability but also that the disability prevents any type of work at all.
These wrongful denials usually result in a dispute between residual disability and total disability. The difference in dispute is often several hundred thousand or millions of dollars. Disabled employees have successfully challenged these denials of coverage by convincing courts that the definition of totally disabled is not as strict as the insurance companies would like.
California Law Regarding Total Disability is Well Settled and Pro-Claimant
A California appellate court addressed this issue in Joyce v. United Insurance Company of America. The plaintiff in that case worked as a toolmaker at the Stanford University Electronics Laboratory. In 1957, he bought a disability insurance policy from United Insurance that would pay him $100 a month if he were totally disabled. In late 1957, he injured his shoulder while moving equipment. A month later, he hurt himself again. This time, he injured his right arm while moving a heavy-duty vise. He tried to return to work six months later but could not work more than a few minutes at a time. As a result, his employer fired him because he could not perform his job duties.
United Insurance denied benefits, claimed the employee’s total disability ended the moment he returned to work. But in California, “total disability” does not mean an “absolute state of helplessness.” Instead, it requires only that the insured cannot perform the “substantial and material acts” necessary to work in the “usual or customary way.” The employee argued that he couldn’t make tools in the usual or customary way because his injured arm would not allow him to move machinery or use his arm for more than a few minutes at a time.
California Disability Insurance Claimant Wins
The California appellate court held that the employee was totally disabled under California law. Even though the employee returned to work twice, the court pointed to the fact that the employee could not perform “substantial and material acts” to work in the “usual or customary way.” And, under California law, a “totally disabled” claimant does not lose this status simply because he can perform sporadic tasks. As the claimant’s attempts to resume work were short-lived, the court properly found the employee should receive disability benefits. If you have been denied disability benefits, contact our California disability attorney for a free consultation.
Joyce v. United Ins. Co., 202 Cal. App. 2d 654 (1962).
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I’m extremely satisfied with the experience I have had with this firm from day one. The lawyer who has handled my case, Alex, is very efficient and attentive to all my questions and concerns. They are always aware of how my case has gone and they care about my health. I feel optimistic with them because they are very attentive during the process of my claim. I would not hesitate to recommend families and friends if in any situation they need their services. Kathleen as well has been very well and assisted me with this case. I highly appreciate everything they have done for me.
It’s unfortunate when disability insurance companies come after older disabled policyholders just to help their bottom line. It can be a living nightmare the damage they can do to a family. Dell Disability Lawyers are polite, understanding and knowledgeable. They call you back and answer any question you have no matter how unimportant it can be. The amount of stress they took off of myself and family was incalculable. I recommend them highly to take care of any disability case whether it be filing for benefits or reversing a claim decision. They are outstanding.
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Without them my LTD company was dropping my plan with me still suffering from my accident, even with doctor’s statements I’m still disabled. The LTD company didn’t want to advance my policy to the next stage of years of pay. Dell Disability Lawyers saved my policy, and helped to enforce the LTD company’s own policy (for its policy holder, me) that I would be covered still under the LTD policy I had paid for at my previous job, when my accident occurred. These lawyers know what they are doing and can help you too. LTD companies will try to drop you when you still need coverage just because they don’t want to pay on your policy anymore. Don’t let them break contract with ya because they are trying to get out of it. Hit em with legal action to ensure the continuation of your policy you paid for. Dell Disability worked very well for me and continue to do so.
I was denied long term disability benefits from The Hartford after being on it for years. I found Dell Disability Lawyers after doing research online. In a matter of days they responded and explained to me everything that would be done. Dell Disability Lawyers were able to settle my suit against The Hartford very quickly and responded to me quickly. I would definitely recommend this team of lawyers for anyone that is fighting for their disability insurance.
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This law firm is the best so far. MetLife denied me two times, they appealed two times for me and they won of course. So if you are on disability and want a chance at winning your case use this firm Dell disability lawyers, kind courteous understanding and they get the job done. You won’t be disappointed.