If Your Individual or ERISA Long Term Disability Policy Contains Any of These Clauses…You Should Be Concerned
The insurance company has the “discretion” to determine your benefits.
You only get paid benefits if you can’t perform “each and every” important duty of your job.
The duties of your job are determined by the insurance companies’ use of the “Dictionary of Occupational Titles,” and not based on how you have performed your job for your employer.
Your benefits are limited to 24 months if your disability is caused, or contributed to in any fashion, by mental illness, depression, or anxiety.
Your benefits are not payable, or can be limited, if your illness is fibromyalgia, chronic fatigue, chronic pain, or an illness in which the symptoms are “self-reported” and not verifiable by any diagnostic study.
Your benefits will be terminated if the insurance company says you can work part-time in any job, regardless of your ability to find such a job.
If you are disabled, or have applied for and been denied benefits, any of the clauses mentioned above will greatly increase your difficulty in getting the benefits you are rightfully owed.
None of the above provisions are required by any law. Nevertheless, even though insurance companies are in no way obligated to do so, many will sneak these nasty little clauses into your policy. Plain and simple, this is a typical example of how insurance companies refuse to pay you in order to save themselves millions of dollars.
Then, amazingly, the same insurance companies will routinely refuse to pay benefits based on their sneaky policy clauses, telling their insureds:
We are sorry your employer bought such a lousy policy,
but we can’t pay your benefits!
Disclaimer and Warning
We know the arguments disability insurance companies make, and we will tell YOU. What many people don’t know is that it’s important to defend yourself against these attacks before you stop working and file a claim for disability. In this book, you will be presented with disability insurance companies’ most commonly used arguments. Common mistakes many people make when filing their disability claims, and how to avoid them, will also be outlined. Please remember, however, that unless you have already hired this law firm, the information presented in this book is considered to be general commentary and opinion only. It is also important to keep in mind that every insurance policy, and every case, is unique.
Please do not send us a detailed e-mail asking, “What do you think?” We would prefer not to give general and vague advice, but to instead evaluate each and every situation, carefully considering all aspects of your particular situation.
If you intend to make a disability claim, or have already done so, having an experienced disability insurance attorney on your side will be of great benefit. Everyone is entitled to the knowledge and assistance an experienced attorney can provide throughout the entire legal process.
Hopefully this information-filled guide will help you to make an informed decision on whether or not to purchase, renew, or reject your company’s current disability policy, perhaps in favor of an individual disability insurance policy.
Whether you are disabled, or you are a medical provider treating victims of disability, this book will provide you with insight into the traps that many disability insurance companies are waiting to spring on you. These traps really do exist, as observed by Judge Enslen, Zanny v. Kellogg Co. and Metropolitan Life Insurance Co., Case No. 4:05-CV-74, June 30, 2006: “Metropolitan Life Insurance Company has arrived at a formula for operating a profitable insurance business. It simply does not allow piddling things like facts to intrude upon its employee benefit claims decisions.”
Answering these broad-based questions isn’t easy. Help is a phone call away. You can contact Nancy Cavey, an experienced long-term disability attorney at 727-894-3188.