Oct 17, 2024 - Disability Insurance by Seltzer & Associates
As a professional, you purchase disability insurance to provide protection for yourself and your family in case a physical or mental condition prevents you from working in your chosen field. It seems like it should be a fair bargain—the insurance company gets to keep your insurance premiums and enjoys a great likelihood that they will pay out little or nothing in return.
But when something happens, and you do need to make a claim for the benefits you have been paying, the insurance company can be very reluctant to approve your claim. As attorneys who focus on enabling physicians, executives, accountants, and other professionals to secure disability benefits from their insurance companies, we know that professionals often have a more difficult time succeeding with their disability claims than workers in less intellectually demanding fields. Understanding the challenges in the process can help you formulate a plan to overcome the difficulties and succeed with your benefit claim, whether you are preparing to file initially or have had your claim denied and need to file an appeal.
The Burden of Proof Can Be Exceptionally High
To obtain disability benefits, you need to prove that your disability prevents you from performing the functions of your profession. This requires substantial evidence, and that evidence is not always easy to obtain. It is necessary to demonstrate the skills and abilities required for your position, the extent of your disabilities, and the various ways in which your disabilities prevent you from performing the necessary components of your job.
Moreover, you have to not only ensure that your arguments are backed by evidence that the insurance company finds persuasive, but you also have to frame your arguments in a logical progression that is accepted by the insurance company. Aspects of your job that you take for granted as necessary, for instance, will need to be explained in detail to insurance evaluators. Otherwise, they will not make the required connections from point A to point B—or point R to point S—and they will reject your claim.
An attorney experienced in pursuing disability insurance claims can help you gather and present evidence in a way that insurance companies can understand. It often requires obtaining specialized statements from physicians and other professionals detailing the impacts of your disability on the specific skills required for your job.
Terms of the Policy
Your ability to receive benefits depends in large part on the terms of your insurance policy and how those terms are interpreted under the law. One aspect of disability insurance policies that often makes it difficult to obtain benefits is an “any occupation” clause. A disability policy can be set up so that you either qualify for benefits if you are unable to perform your “own occupation” or if you are unable to perform “any occupation.”
As you can imagine, it is much more difficult to prove that you are unable to perform any occupation. For instance, if your cognitive functions are impaired and you cannot concentrate well enough to analyze financial records, the insurance company might insist that you are still qualified to push carts at a big box store. Or if you have chronic back pain that prevents you from sitting or standing for extended periods, the insurance company might say you are qualified to work as a telemarketer or online tutor.
It is vitally important to understand the precise terms that apply to your situation. “Own occupation” policies have been interpreted to mean the specific position you held at the time your disability prevented you from working. However, they have also been interpreted—sometimes erroneously—to include positions you have held in the past.
If you are uncertain about the type of coverage you have, the team at Seltzer & Associates would be happy to review it for you. For the greatest protection, you want to ensure that your policy includes “own occupation” coverage, preferably in language that is well-defined.
Cognitive Ability and Mental Health Impairments
People tend to associate the term “disability” with some sort of physical handicap, but the fact is that impairments to mental health or cognitive abilities are often even more devastating to the careers of professionals than most physical disabilities. The stress experienced by medical professionals such as nurse anesthetists or professionals who treat people in a time of crisis, like psychologists and lawyers, can be relentless and lead to debilitating mental health problems such as anxiety and depression that render them unable to continue working.
Conditions that impair a professional’s cognitive abilities are equally debilitating. If you can’t analyze data or make critical decisions in the way you could before, you will not be able to perform any professional-level job in any field.
However, proving disabilities that affect mental health or cognitive abilities can be extremely challenging. It is not a simple process to establish what your cognitive and mental health abilities were before, what you need to be able to do to perform your job, and the limitations of your current abilities. This is another task where the assistance of an experienced disability attorney can prove invaluable.
Stigma and Damage to Professional Reputation
Professionals generally have a hard time admitting that they are unable to function at the high level that has been the hallmark of their careers. It is hard to admit difficulties to themselves, let alone to others. It often takes much soul-searching, and the intervention of family or friends before a professional will file a claim for disability insurance.
One reason for the reluctance is the stigma associated with disability claims and the damage to professional reputation. When your career is built on your high level of skill, knowledge, and performance, acknowledging that something is deficient can cause others to see you differently, and it can change the way you see yourself. It can be difficult to rebuild your career or to move to something different. These concerns often cause professionals to avoid filing a claim or pursuing it vigorously.
However, when you have the foresight to purchase disability insurance, you recognize that things happen in life that are often out of our control and that we need to be prepared in case of these difficulties. This type of preparation should be applauded and rewarded, and there should be no shame in filing a claim for benefits you have paid for.
Experienced Guidance Can Make All the Difference with a Disability Insurance Claim
It is an unfortunate truth that insurance companies are happy to accept your premiums and extremely reluctant to pay benefits. Disability insurance claims involving professionals often offer insurance companies numerous options for denying claims, and when professionals are even the least bit reluctant to assert their right to benefits, insurance companies press their advantage.
At Seltzer & Associates, we know that there are numerous mental and physical conditions that can prevent you from performing at the level required for professional competence and that when you suffer from one of these conditions, you are entitled to receive the disability benefits you have contracted for in your policy. Our team has decades of experience proving to insurance companies that these claims must be paid.
If you have questions about your disability insurance policy or would like assistance filing a claim for benefits or appealing a denial of coverage, we invite you to contact us for a complimentary consultation. To get started, call us at 888-699-4222 or contact us online.