San Francisco Insurance Law Blog

Tricks of the disability insurance trade: Deny until death

What's one sure-fire way insurance companies can avoid paying out a long-term disability claim? When the policy holder dies before he or she can collect.

That seems rather obvious and makes sense -- until you realize that some long-term insurance companies will frequently find ways to delay payment on a long-term disability policy as long as possible, basically hoping that the insured will either give up or die.

Can you protect yourself from a faulty insurance policy?

Having an adequate insurance policy is something that can provide you with more confidence and put your mind at ease because you can secure some form of support and protection in case you are involved in certain accidents. However, if you are struggling with getting the full benefits out of your insurance policy in California because they are refusing to honor the terms of your agreement, you could be facing a difficult battle. 

Familiarizing yourself with the terms and conditions of your insurance policy is central to your ability to know under what conditions it will function. If you have holes in your coverage and are unable to find a customized plan that is adequate for your lifestyle and the unique risks you face, you may wish to look into alternative policies that can provide supplemental protection and give you the peace of mind you need. 

Can work incidents result in long-term disability?

California residents who get involved in work-related incidents can end up with injuries that result in short or long-term disability. In these cases, Pillsbury & Coleman, LLP, are here to help you deal with the insurance situation.

“Work-related incidents” is a term that covers a very large scope of possible happenings which often result in injury to you and other employees. It can cover everything from factory explosions to repetitive stress injuries received from typing too much without getting enough of a break.

Private disability or ERISA? The best policy is both policies.

By Terry Coleman

In years past, professionals who wanted a long-term disability policy would go out in the private market. These policies would protect them if they became unable to practice due to injury or illness. And if that doctor or other professional changed jobs, the coverage would follow them.

Why is my insurer demanding an independent medical exam?

One of the most common questions we get is about independent medical examinations. You are limping along (perhaps literally) on disability, and out of the blue the insurance company wants proof that you are still disabled.

This is disheartening and scary. An unfavorable exam could cancel your benefits or force you to go back to work while you are ailing. Why is the insurer asking for an IME? Are you required to go?

What is 'own occupation' and 'any occupation' disability?

There are two main categories of long-term disability insurance (LTD), based on the definition of disability. The first threshold is “own occupation,” meaning that you receive disability benefits if you are unable to perform your regular job. The other threshold is “any occupation,” meaning that you receive disability benefits only if you are unable to perform any gainful employment.

Every LTD policy is different. The fine print matters, particularly the definition of occupation and the definition of totally disabled. Insurance companies are notorious for selling these policies at significant premiums and then denying claims or terminating benefits. Make sure you read the terms of coverage carefully and talk to an attorney if you ever need to invoke the policy.

Why you should talk to a lawyer before your file an LTD claim

You purchased long-term disability insurance as a hedge against a disabling injury, medical condition or mental health issue. It’s the only way to protect your livelihood, because workers’ comp will not pay anywhere near the income you were earning as a practicing professional.

If that dreaded day comes, you will have to file a disability claim against your policy. Despite diligently paying your premiums every month, there is a high chance your claim will be denied. Your best bet may be to talk to an insurance lawyer before you submit that claim. Here’s why.

Mental health is the new battleground in disability claims

At a time when more people are dying by suicide or overdose, those seeking treatment for mental health issues and addiction face major barriers. Namely, insurance companies are deploying many tactics to deny or limit mental health coverage.

This includes professionals and others who have long-term disability insurance. Mental health claims are denied or downplayed by insurers at a greater rate than medical claims, despite federal legislation.

Important element of disability policies

Most people in California do not ever expect to become disabled. Nonetheless, there is no way to ever completely eliminate this from potentially happening. For this reason, many people do look into buying insurance policies that can provide them with some income should they unexpectedly be unable to work for extended periods of time. These are called long-term disability insurance policies and they do differ from short-term disability policies. 

As explained by Magnify Money, when a person is evaluating long-term disability insurance, they should evaluate a few key provisions to make sure they select the right one for their needs. Different policies may define "disability" in different ways. For one policy, a person may be deemed to be disabled if they cannot work in any job or in any capacity. However, another policy may identify a person as disabled only if they cannot work in the exact profession that they previously worked in.

Multi-count lawsuit alleges ERISA violations

When people in California elect to participate in their employer's retirement account program, they should be able to trust that their money and best interests will be properly taken care of. Every fund that falls under the jurisdiction of the Employee Retirement Income Security Act is supposed to be administered in a way that meets the rules of the program. Unfortunately, this does not always happen and innocent people can be at risk of losing valuable retirement savings or paying too much for their plans.

A new lawsuit has been filed in Texas that alleges a specific ERISA retirement plan was not properly managed. As reported by Plan Sponsor recently, there are four specific counts called out in the complaint. One of the counts asserts that there was a gross failure to monitor ERISA compliance among the plan's committees and the members of those committees. Another count alleges a breach of the fiduciary duty. The final two counts assert that prohibited transactions were engaged in. Some of these were with a fiduciary and some with a party-in interest.

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