We represent people seeking financial recovery from their disability insurance.
Disability insurance benefits are often the only source of income for an injured person and his or her family. When the insurance company refuses to cover, the injured client may experience significant financial hardship. We can help if the insurance company denies your claim.
Many employers provide disability insurance as a fringe benefit while some people purchase their own disability policies. Typically, self-employed business owners buy their own disability policies.
The language of your disability policy will determine the coverage and therefore must be carefully reviewed. For example, some policies cover disability only if the insured cannot work at all, while other policies provide benefits if the insured cannot work in his chosen occupation. Therefore, under the first type of policy, if a surgeon could no longer stand or walk, the policy would not cover since he could do other medical or office work not involving walking or standing, even though standing is an integral part of being a surgeon.
However, under the second type of policy, the surgeon who could not walk would not be obligated to take a lower income job. Under this type of policy the surgeon would be covered if he could no longer stand and operate.
I. Private Insurance versus Employer Provided Insurance (ERISA)
Generally, privately purchased disability insurance will provide greater benefits than those provided as a fringe benefit by an employer. Many business owners and professionals purchase their own disability insurance which allows greater flexibility in the coverage, definition of disability, and benefits.
In comparison, some employers offer disability insurance as a fringe benefit of employment. The employee might pay nothing for the insurance, contribute to the cost, or pay the entire cost. Often, the employee has no choice in plans or the coverage.
One important difference between privately purchased insurance and group disability insurance provided by an employer, is that the employer provided insurance will be controlled by the federal law of the Employee Retirement Income Security Act better known as ERISA. It is a federal law governing pensions and employee benefits.
Under a group policy provided by an employer, the law of ERISA will apply. The employee must go through an appeal process to contest the insurance company’s denial. The insurance company acts as judge and jury. An adverse appeal can be contested in a federal court only if the insurance company’s decision was not based on the record before it. In other words, the court will grant great deference to the insurance company’s decision.
In comparison, in a private disability policy the employee need not go through an appeal process. The client can go straight to court. There is a lesser burden in proving disability and the right to benefits.
We have handled both ERISA and private disability cases with success.
II. Success Stories – Disability Insurance
*Charlie Radcheck had a private disability insurance policy. He was a full-time car service driver.
Charlie developed post-traumatic seizures as a result of a motor vehicle accident. As a result, his neurologist recommended that Charlie should no longer drive for a living.
The insurance company denied the claim. It claimed that Charlie could drive as evidenced by an investigators secret taping of Charlie driving to the local store and shopping. However, at no time did Charlie and his doctors state that he was housebound. The medical evidence established post-traumatic seizure disorder, and Charlie could not take the chance of being on the road eight to ten hours a day.
We settled with the insurance company for $800,000 which included past benefits and future benefits in a lump-sum buy-out of the policy.
*Billy Ray James was a truck driver. He had a motor vehicle accident which injured his back and required had surgery.
Billy Ray’s insurance company refused to pay benefits even though Billy Ray qualified for Social Security Disability. We had to bring suit, and the insurance company settled for $290,000 for a buy-out of the policy and past benefits.
The clients’ names have been changed to protect client identity. Prior results do not guarantee a similar outcome.