If a long term disability policy holder files a claim and meets all the initial eligibility requirements and the claim is not precluded by any exclusions or limitations expressly written in the policy, approval or denial will hinge on whether the insurance company makes the determination that the claimant is disabled under the policy definitions. As a New York long term disability attorney reports from experience, this is no simple matter.
Definition of Disability
Each policy must be read for the specific language it contains, but a common definition observed by a New York long term disability attorney is that a claimant is disabled and therefore eligible for long term disability benefits if, due to an injury, illness or disease, they are unable to perform the duties of their employment.
While it may be surprising to many, a New York long term disability attorney reports that over 90 percent of long term disability benefits are paid due to illness and disease and not due to injury caused by an accident. According to the Council for Disability Awareness, some of the more common conditions include:
• Disease of the musculoskeletal system and connective tissue or other disorders concerning muscles, joints and the back;
• Cancers and tumors;
• Cardiovascular and circulatory system diseases including heart attacks, heart disease, strokes and hypertension;
• Pregnancy and complications of pregnancy;
• Mental disorders including mental illness, depression, bipolar disorder, substance abuse and anxiety;
• Diseases of the nervous system such as Alzheimer’s Disease, Parkinson’s Disease, Multiple Sclerosis, eye disorders and ear disorders; and
• Respiratory system disorders such as asthma, bronchitis, emphysema and cystic fibrosis.
Injuries and Accidents
Statistically, only about 8 percent of long term disability cases are due to an injury or an accident. The primary reason for that is due to an exclusion that most disability insurance companies have in their policies. According to a New York long term disability attorney, most policies exclude any injury that was the result of an employment-related incident because of the remedy that is provided by workers’ compensation for such occurrences.
Injuries not occurring in the course of employment are covered by long term disability policies. Most common among these are automobile accidents and falls at home.
Many people have conditions that remain permanent and stationary while some conditions deteriorate. Other times, however, a disability recipient’s condition may improve. Depending on the nature of the condition and the insurance company, a New York long term disability lawyer indicates the individual may have to undergo a continuing disability evaluation.
Changing Policy Terms
It is not uncommon for a long term disability policy to pay benefits for two years if the claimant cannot perform the duties of their “own occupation,” and the policy thereafter switches to paying benefits only if the person cannot perform the duties of “any occupation,” which is a much lower standard.
Contact a New York Long Term Disability Lawyer for Legal Advice
The fact that a claimant cannot work is not persuasive to an insurance company; denials are frequent. Experienced counsel can, however, make a difference. For a free case evaluation, call Hermann Law Group, PLLC, at 1-877-773-3030.