What to do if you have a disability claim.
Disability insurance policies are ‘peace of mind’ contracts that pay you a portion of your lost income if you become “disabled” from working as a result of illness or injury. These can be individual/private plans or policies (paid for privately by the person wishing to be insured) or group plans or policies (paid as part of your employment package).
The contract or policy will set out the definition of disability. Contractual definitions are always open to interpretation. Generally you will qualify for benefits if you are not able to do all, or substantially all, of the duties of your current occupation – sometimes referred to as the “own occupation” definition. Many policies will also change the definition of disability a set period (usually 2 years) to that of “any occupation” – meaning you have to prove that you are not only disabled from working in your own occupation but also in ANY occupation. Again this is open to interpretation – the courts have held that “any occupation” means any occupation similar in status and pay to your former occupation.
Generally, you will be considered disabled if the injury or illness is such that common sense requires you to stop working so you can focus on getting better.
Disability claim cases are often denied for “lack of medical evidence”. Our disability claim lawyers have successfully resolved denied claims by bringing forth the medical evidence required to prove the disability as defined under the policy.
Even in circumstances where the insurance company permits you to appeal the decision, it is still important to seek legal advice from a disability claim lawyer for the following reason:
YOU ONLY HAVE A LIMITED TIME WITHIN WHICH TO TAKE LEGAL ACTION. THIS IS CALLED A LIMITATION PERIOD. WHEN THE TIME LIMIT BEGINS TO RUN WILL DEPEND ON THE FACTS OF YOUR CASE.
Time limits are not the same for every policy and every circumstance and that is why it is essential to get legal advice to know what time limits apply in your particular circumstance.
If an insurer has wrongfully denied you benefits, you may have no alternative but to take legal action.
If you are considering filing a disability claim against your insurance company:
DO:
DO make sure you file the claim in a timely manner to avoid missing deadlines.
DO keep records of everything related to your disability case.
DO take notes of your conversations with the insurance companies and your doctors and nurses.
DO be honest with your doctor.
DO read your insurance policy – familiarize yourself with the part of your policy that dictates the proper procedure for filing a claim.
DO be honest when filing your claim – fraudulent or exaggerated claims can backfire on you, and can even mean serious criminal charges.
DO contact Fishman Lawyers in the event that your claim is denied.
DO provide your lawyer with the proper documentation including: the insurance contract, benefits booklet, medical records and correspondence with the insurer; your complete medical history document, including doctor diagnoses, specialists visited, major test results, specific timeline of condition, medications taken, prognosis reports, family situation, physical and mental restrictions; the effects of the disability on your everyday life, financial effects, recreational effects (what activities are you now unable to do because of the illness or injury); and how your condition prevents you from performing your job – be prepared to discuss every aspect of your claim.
DON’T:
DON’T sign anything from the insurance companies without carefully reviewing it first – it could potentially be used against you during your case.
DON’T let too much time go by – there is a limitation period on your disability claim.
DON’T overdo – or participate in activities in public that might be construed as proof that you are not disabled. The insurance companies may document this, even with video, and may use this against you.
DON’T file one claim at a time – if you’re disabled in more than one way, don’t let the insurance companies tell you that you can only file one claim at a time. Your policy covers your entire body and potentially all the ways it can be disabled.
DON’T cut back working hours – by opting for fewer working hours because of your disability, you may be inadvertently giving up your disability benefits.
DON’T settle for less than you deserve.
DON’T delay in contacting an experienced disability insurance lawyer after your claim has been denied or terminated – the earlier a lawyer is involved, the better your chances are of getting maximum benefits.
