Pillsbury & Coleman, LLP
We Can Help You. 415-655-1549
Toll Free: 866-460-7279

Provisions to be aware of in long term disability contracts

It is not uncommon for today’s professionals to feel a significant obligation to their clients. While this commitment is admirable and essential to their success, some professionals may carry this burden even in the midst of debilitating illnesses or chronic pain. As much as someone wants to do for their clients, what happens when they cannot work?  

One would think that in these instances, long term disability (LTD) insurance will be the stopgap that was promised when the policy was originally sold. Depending on the stage of their career, an injured professional may even rely on their (LTD) policy to usher them into retirement.

This appears to be a sound cause of action, but the insurance company may not cooperate. LTD insurers may be especially skeptical when it comes to claims based on fibromyalgia and chronic fatigue syndrome (CFS). These ailments were once considered “fringe” conditions that the medical community did not recognize or understand. As such, claims based entirely (or in part) on CFS or other chronic soft-tissue ailments were denied. However, with technological advances more physicians understand how the ailments work and now give credence to conditions that chronic pain sufferers have known for years.

Even with new and evolving knowledge, some disability insurance companies will attempt to limit their exposure for payment by including vague and unfamiliar terms that could have a number of interpretations or provide arbitrary limitations for conditions that would justify payment.

With that, claimants must be wary of provisions such as “soft tissue order condition limitations” and “self-reported symptoms and conditions.” It is critical for professionals considering LTD insurance to fully understand how these provisions work so that the proper expectations can be developed in the event chronic, soft-tissue ailments derail one’s career.

If a dispute arises over coverage of chronic pain or similar ailments, the knowledge and experience of a skilled bad-faith insurance attorney can make the difference between obtaining the money you deserve and taking another turn on carousel of insurer excuses.

For more information, we invite you to contact us.

The preceding is for informational purposes only and is not legal advice.

No Comments

Leave a comment
Comment Information
Email Our Attorneys

We Can Help You

Bold labels are required.

Contact Information
disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

close

Privacy Policy

  • American Board of Trial Advocates
    American Board of Trial Advocates A prestigious national association of experienced trial lawyers and judges. Membership is by exclusive invitation only. All members shall have completed 10 civil jury trials to jury verdict or hung jury as lead counsel.
  • Best Lawyers
    Best Lawyers The oldest and most respected peer-review publication in the legal profession. A listing in Best Lawyers is widely regarded by both clients and legal professionals as a significant honor, conferred on a lawyer by his or her peers.
  • AV | PeerReviewRated | Martindale-Hubbell | For Ethical Standards and Legal Ability
    Martindale-Hubbell Peer Review Ratings An objective peer review rating indicator of a lawyer's high ethical standards and professional ability, generated from evaluations of lawyers by other members of the bar and the judiciary. Pillsbury & Coleman founding partner Philip L. Pillsbury Jr. is rated “AV Preeminent.”
  • Super Lawyers
    Super Lawyers A peer-review rating service of outstanding lawyers from more than 70 practice areas who have attained a high-degree of peer recognition and professional achievement.
  • Best Lawyers | Best Law Firms | U.S.News & World Report | 2018
    Best Lawyers Best Law Firms U.S. News 2017
  • American Association for Justice | Formerly the Association of Trial Lawyers of America (ATLA)
    American Association for Justice (AAJ) Founded in 1946, AAJ is the world’s largest trial bar and supports the work of attorneys to ensure that injured plaintiffs can obtain justice.
  • IACCEC
    American College of Coverage and Extracontractual Counsel Composed of preeminent insurance coverage counsel in the United States and Canada, representing the interests of both insurers and policyholders. The minimum membership requirement is the practice of insurance law for at least fifteen consecutive years.
  • Association of Business Trial Lawyers | abtl
    Association of Business Trial Lawyers Founded in 1972, ABTL is dedicated to connecting litigators and judges to address issues important to trial lawyers.
  • Consumer Attorneys of California
    Consumer Attorneys of California The only California-wide unified trial bar for plaintiffs lawyers who represent consumers harmed by powerful foes such as insurance companies, pharmaceutical companies, automobile manufacturers and banks.
  • SFTLA | San Francisco Trial Lawyers Association
    San Francisco Trial Lawyers Association For over 60 years, this prestigious bar association has educated and trained trial lawyers and supported and passed critical legislation to protect and advance individuals’ rights.
  • United Policyholders | Empowering the Insured
    United Policyholders A non-profit group dedicated to providing trustworthy and useful information and an effective voice for insurance consumers in all 50 states.
  • America's Top 100 High Stakes Litigators | 2018 | Top 100
    ACCEC | American College of Coverage and Extracontractual Counsel | Fellow