If your short-term term or long-term disability insurance plan includes any potential vulnerabilities, that’s okay — you are not without options. Illinois law requires that ambiguous provisions be interpreted in favor of the policyholder, so any particularly confusing or unclear provisions may not necessarily follow the insurer’s desired interpretation. Further, even if you are subject to a challenging restriction (i.e., “any occupation” limitations), with the aid of a skilled attorney, you may be able to gather the evidence necessary to prove that you satisfy the requisite conditions.
Potential Vulnerabilities in Short-Term and Long-Term Disability Insurance Plans
Curious about the weaknesses in your insurance plan? Consider the following.
- Related Article: 5 FAQs About Private Disability Insurance Claims
Percentage-Based Benefits Limited by a Low Cap
Generally speaking, most short-term and long-term disability insurance plans pay percent-based benefits. If you are a middle-income or high-income earner, then a percentage-based benefits scheme is quite advantageous — for example, if you earn $8,000 a month, and you have agreed to a benefits scheme that involves 60 percent of your salary as short-term or long-term disability benefits, then you could be eligible to receive $4,800 per month.
It’s worth noting, however, that some insurers get around the “risk” of having to pay percentage-based benefits by establishing a cap on liability. This cap may be rather low in comparison to your potential benefits were the percentage to fully apply. Taking the above example, though you would otherwise be entitled to receive $4,800 in benefits per month, the insurer might have set a cap at $3,000 to ensure that you cannot obtain your benefits in full.
Plan Establishes an “Any Occupation” Limitation on Disability
Disability coverage may involve an “own occupation” definition of disability or an “any occupation” definition. What’s the difference?
Own occupation plans allow the policyholder to receive disability benefits so long as they can show that they have been rendered unable to perform the duties of their pre-existing occupation. This means that a policyholder could ostensibly supplement their income by working a different occupation.
Any occupation plans prohibit the policyholder from receiving disability benefits if they are capable of working in any alternative occupation (that they are qualified for). For example, if you suffer a severe back injury that renders you incapable of working in your previous capacity as an on-site foreman, your insurer may deny benefits on the basis that you could switch to an administrative desk job (and that you are qualified to do so).
Broad Exclusions Built Into the Insurance Plan
Disability insurance plans vary wildly — in some cases, an insurance plan can broadly exclude a number of illnesses, so assess the exclusion categories that are built into your plan. Some plans do not outright exclude a particular illness or injury, but will establish a significant additional waiting period before you are deemed eligible to receive benefits for the disability at-issue.
Length of Disability Coverage is Insufficient
Length of coverage is of critical importance, and there are significant differences between plans. Suppose, for example, that you have been diagnosed with cancer, which renders you disabled. Chemotherapy and surgery processes (and subsequent recovery) may take up to four or five years. Your long-term disability coverage lasts for only two years, however. Short coverage periods may lower your premium payments, but can put you in a particularly vulnerable position should you subjected to a serious disability.
Significant Waiting Period for Benefits
Significant waiting periods can force you to pay out-of-pocket when you lack the necessary funds. Unfortunately, many policyholders gloss over waiting period provisions when signing up for short-term and long-term disability coverage.
Mental Illness Exceptions on Length of Coverage
Some insurance policies may institute certain limitations for policyholders whose disability is caused or contributed by a mental illness. In such cases, you may still be entitled to receive benefits, but those benefits may be limited. For example, you may have a long-term disability insurance plan that pays out benefits until standard retirement age (i.e., 65 years old), but the plan may also include a provision that limits the receipt of benefits for mental illness to two or three years.
Contact an Experienced Chicago Private Disability Attorney for Legal Assistance
If you have had your short-term disability or long-term disability claim delayed, undervalued, or denied by your insurer, then you may be entitled to challenge the insurer’s decision. In the event that the insurer refuses to change their decision following an internal appeal, you may be entitled to sue and recover damages in an Illinois court of law.
Here at Bryant Legal Group, P.C., our attorneys have successfully represented policyholders in a range of disputes with their insurance companies, including disputes that involve short-term and long-term disability issues. We are committed to our clients, and we recognize that being involved in an insurance dispute can be an emotionally trying and difficult process, particularly if you don’t know how your case is progressing — as such, we strive to keep clients apprised of new developments in their case.
Call (312) 561-3010 to speak with an experienced Chicago private disability attorney here at Bryant Legal Group, P.C.