Category: Blog
Disability Insurance: A Look at Ambiguous Exclusion Clauses
Apr 30, 2018 | Blog | ShareAs a general rule, insurers do everything possible to minimize their liabilities. In the disability insurance context, this may involve the denial of an otherwise legitimate benefits claim on the basis of an exclusion written into the insurance policy. Exclusions are often written in a particularly ambiguous way, however, so as to encourage prospective policyholders to enter the insurance agreement — the policyholder may interpret the exclusion in a broad and more favorable manner, when the insurer actually intends to interpret the exclusion more strictly. Once you have become disabled, the insurer’s interpretation of the exclusion may come as something […]
Seventh Circuit: ALJ Impermissibly “Played Doctor” In Denying Fibromyalgia Disability Claim
Apr 26, 2018 | Blog | ShareAndrew Bryant & Jennifer Danish On April 4, 2018, the Seventh Circuit Court of Appeals issued an opinion vacating the denial of a Supplemental Security Income disability claim brought by 47-year-old Rebecca Ann Akin, who suffered from fibromyalgia, back and neck pain, and headaches. Akin v. Berryhill, 887 F.3d 314 (7th Cir. 2018). On appeal, Akin argued that the administrative law judge wrongly discounted her allegations of back pain, improperly credited the opinions of agency doctors who had not reviewed all the medical records (including MRI scans) and disregarded her history of headaches. In its opinion, the Seventh Circuit described […]
Insurers Must Act in Good Faith When Handling Claims
Apr 23, 2018 | Blog | ShareIn Illinois, and throughout the country, the nature of the insurance business — whether in the health insurance, property insurance, business liability insurance, or disability insurance contexts — is to sign on policyholders while limiting the payout amount in a potentially covered event. Considered from the perspective of the insurance company, success is being able to deny coverage for a legitimate claim, or perhaps delaying the processing of the claim to such an extent that the policyholder simply withdraws from any further attempt at recovering their rightful benefits. State and federal law grants policyholders a number of rights, however, centered […]
As a long-term disability (LTD) insurance policyholder, you may find yourself in a particularly vulnerable position. Despite the fact that you have been rendered disabled, your insurer may delay, undervalue, or deny your legitimate claim for long term disability benefits. Insurers are always on the lookout for opportunities to minimize their various liabilities. If you are receiving supplemental income, your insurer may see it as an opportunity to avoid having to pay out benefits. Fortunately, in most cases, you are entitled to received LTD benefits even if you are receiving supplemental income from various sources. You may even be entitled […]
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 […]
What are the Advantages of Private Disability Insurance vs. Social Security Disability Income?
Mar 30, 2018 | Blog | ShareMany disability insurance policyholders do not fully understand the structure of their insurance policy and the various advantages afforded by such coverage (in comparison to the default Social Security Disability Income (SSDI) benefits they might otherwise be compelled to qualify for). Private disability insurance may be obtained through an individual insurance plan, or through a group plan (i.e., an employer-sponsored plan), and as a general rule, there is enormous variety in how private disability insurance coverage is implemented. As such, it may not always be obvious to a policyholder how private disability insurance coverage is “better” than SSDI coverage. Let’s […]
Business overhead expense (BOE) disability insurance — otherwise known as business expense insurance — serves as replacement “resources” in the event that the policyholder is disabled and is rendered incapable of working, thus resulting in diminished revenues. BOE insurance is generally purchased in situations where one (or a few) individuals are responsible for generating business revenue, or are otherwise critical to the basic functioning of the business at-large. For example, a small consulting business with four employees might purchase BOE insurance for its top consultant, as, in the event that the consultant is disabled for a period of time, a […]
What Conditions Automatically Qualify You as Disabled?
Mar 16, 2018 | Blog | ShareIf you are currently suffering from a debilitating medical condition, then you may be entitled to recover disability benefits pursuant to your private disability insurance policy. As a general rule, insurers look for any possible justification to deny, delay, or undervalue disability insurance claims, but if your condition qualifies automatically for disability benefits, then you will be at a significant advantage when attempting to recover such benefits. Normally, “automatic qualification” for disability benefits is associated with Social Security Disability Insurance (SSDI), where, if an individual is suffering from one of a long list of severe illnesses, injuries, and other conditions […]
To Assert or Not To Assert Assignment in Out-Of-Network Payer/Provider Disputes
Mar 14, 2018 | Blog | ShareBy: Andrew B. Bryant Two recent federal district court cases highlight the importance of properly pleading (or not pleading) assignment of rights in an out-of-network provider’s state law complaint for payer reimbursement. In the Southern District of New York, plaintiff/provider filed suit in state court against Aetna, bringing various state law claims based upon the insurer’s alleged failure to pay usual and customary charges for two medically necessary surgeries performed by the out-of-network provider. Aetna removed the matter to federal district court, asserting federal question jurisdiction via the position that the provider’s claims were preempted by ERISA. While ERISA claims […]
On What Basis are Life Insurance Claims Typically Denied?
Mar 9, 2018 | Blog | ShareWhen a life insurance claim is denied, delayed, or otherwise handled in a way that prevents the rightful beneficiaries from securing the benefits to which they’re legally entitled, it can leave the beneficiaries in a highly vulnerable position. Not only must a beneficiary shoulder the emotional burden of grieving (and readjusting to a life without their loved one), but if their legitimate life insurance claim is denied, the beneficiary must also come face-to-face with serious financial ramifications — this is especially true in situations where the deceased person provided financial support during their lifetime. Common Reasons for Life Insurance Claim […]