High-earning and/or self-employed professionals are often either not provided with long-term disability or short-term disability coverage as an employee benefit or not provided sufficient coverage to supplement a period of lost compensation caused by health issues or an injury.
To compensate for this deficiency, professionals such as physicians, lawyers and engineers must commonly purchase independent policies to cover any lost wages.
These independent policies are general contracts of insurance that are not covered by ERISA, but like most employee benefit plans, they require an application before insurance carriers such as Northwestern Mutual or Prudential Insurance Company will pay the benefits.
What’s Often Behind Insurance Denials
Crucial to the application process is the “proof of loss” stipulation, which requires that the insured professional must:
(1) show that they can no longer perform one of the material functions of their job because of an illness or injury, and
(2) demonstrate that they have a loss of earnings. This often requires proof beyond a doctor’s opinion regarding the professional’s physical capabilities. Instead it will revolve around the professional’s work output, billable hours or even the type of work that can be done.
Many times, long-term disability and short-term disability benefits under these independent policies are denied because the doctor, lawyer or other professional is unable to deliver the specific information the insurance company needs to prove either lost earnings or the inability to perform a material element of the job.
The intricacies of why an injury or illness prevents the professional from performing a certain task can be difficult. This is because insurance companies will generally limit an analysis to whether a job is sedentary, light duty, medium duty or heavy duty in nature.
Many professional-services careers are inherently sedentary, but many illnesses or injuries do not require physical restrictions or limitations that are sub-sedentary, meaning they often do not require you to be bedridden. But just because you are not physically restricted and limited to a sub-sedentary level does not mean that you are able to perform material duties of your job.
In short, it becomes difficult to explain why a lawyer whose primary tasks involve minimal physical exertion is disabled and unable to perform certain material duties because of a heart attack two years prior.
Why a Long-Term and Short-Term Disability Attorney Matters
Knowing what information to present and how to present it in a compelling way to a claims adjuster is the most important aspect of applying for long-term or short-term disability benefits under a privately purchased insurance policy.
The knowledge of how to address these insurance companies is also important if a lawsuit is necessary. While the restrictions and limitations that govern an ERISA long-term or short-term disability plan do not apply to independently purchased policies, the internal process under these policies is nearly identical.
Having an attorney that understands the ins and outs of the application and internal-appeal processes is almost crucial to prevailing in a lawsuit for a wrongful denial of benefits under these independently purchased professional plans.
If you are applying for long-term disability benefits or short-term disability benefits under an independently purchased professional long-term disability insurance plan, you need the assistance of experienced attorneys that know how and what to present in support of your claim for benefits.
Health Benefit Denials & Insurance Litigation: Contact Us Today
If you are trying to obtain long-term or short-term disability benefits from an independent policy and would like legal insight and assistance, contact the long-term disability and short-term disability attorneys at Gallagher Davis at (314) 725-1780. We can review the details of your application or case with you and determine the proper next steps.
With experience in all state and federal trial and appellate courts in the St. Louis metropolitan area, as well as throughout Missouri and the Midwest, our attorneys provide vigorous advocacy and representation in justly receiving benefits to which you are entitled.