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.

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