State of Vermont Abolishes Discretionary Clauses in ERISA Disability Policies

Our disability attorneys have been strong supporters and advocates in abolishing discretionary clauses from disability insurance policies on a nationwide basis. We are happy to report that in July 2012 the state of Vermont became the 20th State to prohibit discretionary clauses. This is a great victory for Vermont residents and levels the playing field for challenging denied disability claims in court.

The Vermont Department of Insurance drafted a report on discretionary clauses in January 2012 to the Vermont House and Senate Committee on Health Care which detailed all of the problems with allowing discretionary clauses.

A New Law That Protects Vermont Disability Insurance Claimants

Finally in July 2012, the Vermont legislature passed the following law:

§ 4062f. DISCRETIONARY CLAUSES PROHIBITED

(a) The purpose of this section is to ensure that health insurance benefits, disability income protection coverage, and life insurance benefits are contractually guaranteed and to avoid the conflict of interest that may occur when the carrier responsible for providing benefits has discretionary authority to decide what benefits are due. Nothing in this section shall be construed to impose any requirement or duty on any person other than a health insurer or an insurer offering disability income protection coverage or life insurance.

(b) As used in this section:

(1) “Disability income protection coverage” means a policy, contract, certificate, or agreement that provides for weekly, monthly, or other periodic payments for a specified period during the continuance of disability resulting from illness, injury, or a combination of illness and injury.

(2) “Health care services” means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.

(3) “Health insurer” means an insurance company that provides health insurance as defined in subdivision 3301(a)(2) of this title, a nonprofit hospital or medical service corporation, a managed care organization, a health maintenance organization, and, to the extent permitted under federal law, any administrator of an insured, self-insured, or publicly funded health care benefit plan offered by a public or private entity; as well as entities offering policies for specific disease, accident, injury, hospital indemnity, dental care, disability income, long-term care, and other limited benefit coverage.

(4) “Life insurance” means a policy, contract, certificate, or agreement that provides life insurance as defined in subdivision 3301(a)(1) of this title.

(c) No policy, contract, certificate, or agreement offered or issued in this state by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services may contain a provision purporting to reserve discretion to the health insurer to interpret the terms of the contract or to provide standards of interpretation or review that are inconsistent with the laws of this state, and on and after July 1, 2012, any such provision in a policy, contract, certificate, or agreement shall be null and void.

Our disability attorneys have helped disability claimants in Vermont and Nationwide to collect disability insurance benefits. Contact us for a free consultation to discuss your claim.

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Questions About Hiring Us

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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Noah P.

A few years ago I found myself unable to work and needing treatment. While I was getting the treatment I needed my employer fired me. This left me still needing treatment as well as needing to find a source of income. Not knowing where to turn or what to do my wife an I contacted Dell & Schaefer for help. Upon speaking with attorney Stephen Jessup we felt assured that we had found the help we needed. Attorney Jessup worked with the attorneys from my former employer and explained my situation to them. During the weeks of negotiations attorney Jessup kept us informed as to the progress and ultimately called us with a settlement offer. We were so relieved and grateful!

But that is not where our story ended. After informing us of the offer presented by my former employer, attorney Jessup advised me that he felt he could get us a better settlement with just a bit more time. I discussed it with my wife and we both felt confident in attorney Jessup’s advice so we allowed him to further negotiate on our behalf. Sure enough, a more equitable settlement was reached in a very short time. During the entire process attorney Jessup and the staff at Dell & Schaefer handled everything with very little input needed from us. This allowed me the time and reassurance that I needed in order to heal. Their professionalism and reassuring manner never left me feeling concerned that I wasn’t being fully represented despite the fact that they rarely needed participation directly from me. In the end my confidence in them was rewarded with a better settlement than I was expecting. My wife and I are forever grateful. From my experience it would be very difficult for Dell & Schaefer to improve upon their process.

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