Tips for Suing an Insurance Company
- By Admin
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- 18 Oct, 2019
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When you face a long-term disability claim denial, many thoughts begin to rush through your mind. What are you going to do now? Should you sue your insurance company? If you do intend to sue your insurance company, you have a lot to consider. These tips will help you ensure you receive what you are entitled to without making a mistake that benefits your insurance company if you need to take it to court.
Know When to Be Concerned
Has it been months since you filed your claim, but you've received no payment? The insurance company could deny your claim. Many people receive approval within a reasonable time, so you are right to be concerned if you have been unable to receive payments for such a long time.
Back Up Your Information
Treat all documentation as important, which means you should keep all photos, medical records claim, documents, and other correspondence in one location. You must be able to prove you are disabled from working – a letter from your doctor helps out insurance companies and doctors too!
In addition, keep a log of your communications with the insurance company. Document phone calls, emails, and written letters. Take detailed notes in which you indicate who you spoke to, their phone number, and what you talked about. Your insurance company is sure to keep detailed information, so ensure you are not left out of the loop.
Speak Clearly and Politely
While you may not be very happy with your insurance company, avoid writing or communicating you would not want the judge to see. Insurance companies may record their phone calls, which could be used in court to haunt you. A phone call could undermine your credibility, which ultimately impacts your case. Always be polite – insurance adjusters do not respond well to threats or anger.
Hire a Disability Attorney
Remember that your insurance company will have their own attorneys to manage their case. Insurance companies have the power to hire large teams of attorneys who are experts at fighting disability claims.
You are wise to hire an attorney to make it a fair fight. Not just any attorney will do; you need one who understands how to square off against high-profile insurance companies and their lawyers.
Scott Shaffman Attorney At Law is knowledgeable and skilled with disability claims. If you have been disabled and the insurance company refuses to pay, you cannot wait. Call us today to discuss your case.
The language in a disability policy can vary from one insurance company to the next. This can make it difficult to determine exactly what your disability benefits are when you have sustained a serious injury.
Two common areas of confusion in long-term disability policies are the definitions of occupation and job duties. Legal arguments in long-term disability claims often center on the definitions of occupation and job duties, so you need to be able to understand the language in your policy if you want to know your rights.
Own-Occupation vs. Any-Occupation
When it comes to defining a disability, most policies will provide benefits for either an own-occupation disability or an any-occupation disability. If your disability policy can be classified as an own-occupation policy, you will be able to obtain benefits if you sustain an injury that prevents you from performing the duties associated with your current occupation.
This means that even if you are able to obtain a position in another occupation, you can still apply for disability benefits because of your inability to continue to work in your chosen field.
Many long-term disability policies are categorized as any-occupation policies. If the language in your policy refers to any-occupation coverage, you will only be able to access benefits if you are unable to work in any capacity.
You may need to work with your attorney to have the court qualify your policy to require the insurer to provide you with benefits if your injuries prevent you from obtaining a job for which you have sufficient education, training, or experience.
The level of disability required to obtain benefits differs between an own-occupation and an any-occupation policy, so you should know which type of language is used in your policy before you file a claim.
Material Duties vs. Substantial Duties
Long-term disability insurance policies will often state that benefits can only be obtained when a claimant is unable to fulfill the material and substantial duties of their occupation. Though it sounds like these duties are lumped together, many insurance companies evaluate them on an individual basis.
Material duties are categorized as those tasks that must be done as part of an occupation. In other words, if you couldn’t complete the material duties of your job, it would be impossible to do your job the right way.
Substantial duties are important to job performance but don't encompass the entire job description. For example, if you were a sales representative who had a stroke and lost the ability to speak, you would be unable to perform the substantial duties of your job. You may still be able to interact with clients via email, however, so not all aspects of your occupation would be impossible.
There is a lot of overlap between material and substantial duties. Your attorney should be able to establish the specific duties that you fulfill at work each day if you file a disability claim. Showing how your workday differs from a watered-down and generalized job description will help you prove your claim more effectively.
The outcome of a disability claim depends, in large part, on the specific language used in the claimant's insurance policy. Occupation descriptions, essential job duties, and what defines a disability can vary from one policy to the next.
An attorney can help you better understand whether your policy uses own-occupation or any-occupation language, and whether or not your disability limits your ability to complete material duties, substantial duties, or both.
Contact Scott E. Shaffman, Attorney At Law to schedule a free consultation so you can learn more about the specifics of your long-term disability policy.
