Insurance companies deny or terminate claims for many reasons. One common reason is the purported failure to meet the definition of “disability.” Many long-term disability policies have changes in the definition of “disability” after 24 months of benefits, requiring you to be disabled not just from your “own occupation,” but from “any occupation.” The insurance company will frequently “cherry pick” your medical records, even retain an “independent” medical reviewer to build evidence against you, despite the fact that you’ve never been personally evaluated by that reviewer. Although the road ahead can seem difficult, don’t give up on disability benefits you rightfully deserve. Insurance companies often count on you not fighting your benefits, thus saving them from paying you for the months – and often years – of benefits to which you’re entitled. We’ve secured millions of dollars in benefits for our clients and can help you, too. Contact us, and we will help investigate and explain why this happened and how to can help.

To best answer this question, we would need to review your policy documents and look at your particular claim. In many cases, yes, they can. It is very common for the insurance company to hire independent doctors to conduct reviews, and they are allowed to do it in most cases. They usually do not have to defer to your treating providers, although their failure to do so is something that we address all of the time. Under the federal law that governs most of these benefits, the standard is whether the insurance company’s reliance on the independent reviewers over your treating providers was reasonable, and there’s much that goes into this analysis.

Not without speaking with an attorney first. Don’t resign, enter into a severance agreement, or make any retirement decisions without first fully understanding the impact on your disability benefits. Any resignation or severance agreement may impact your eligibility for disability benefits, and there are ways to sever employment while still protecting your disability benefits. Contact the Firm for a policy/plan document review.

The answer depends on your policy. With respect to disability benefits through a private or employer-sponsored policy, disability benefits may be reduced by “other income,” which could include worker’s compensation. You should make sure to pursue any worker’s compensation options available to you if you have been injured at work. We focus exclusively on disability benefits law for residents in Arizona and often work in conjunction with attorneys specialized in other areas of law and can provide excellent referrals.

No. But if an employer decides to offer disability insurance, then usually, the federal statute ERISA governs those disability insurance benefits. Because disability benefits are not a requirement of employers to provide in the workplace, employers are generally allowed to draft or purchase coverage as they see fit. ERISA does not mandate that certain types of disabilities must be covered, or how much of a monthly benefit an employee should be provided. For example, employers can exclude certain disabilities from coverage, such as mental nervous conditions, or adopt very strict criteria for obtaining benefits. For this reason, if you have coverage through your employment, it is imperative to obtain and fully understand your plan/policy documents to determine the particulars of your coverage. We can help you, even in providing guidance on how to request documents (hint: put the request in writing!).