Orange County Long Term Disability Attorney
People buy insurance in an effort to feel more secure knowing they will be taken care of in the event of an accident or injury. Individuals with long term disabilities rely on their benefits for survival and many have no other means of support. Sadly, insurance providers often take advantage of or mistreat those with long term disabilities and fail to provide adequate insurance coverage. This type of insurance fraud is known legally as “bad faith,” which refers to several unfair or fraudulent practices insurance companies partake in to delay or deny the payment of a valid claim. Those who are the victim of insurance bad faith have the right to take legal action against their insurance company.
If you or someone you love has been denied long term disability insurance or is facing other insurance bad faith issues, we advise you to consult with a qualified and trusted attorney who can help protect your legal rights and maximize your interests. Please contact Aitken * Aitken * Cohn today for a FREE consultation with an experienced and caring Orange County personal injury attorney.
Examples of Long Term Disability Bad Faith
Insurance fraud is prevalent in the United States. Sadly, many companies take advantage of members of society who are suffering from long term disabilities. Examples of long term disability insurance bad faith may include:
- Policy benefits are denied for invalid or fraudulent reasons
- Benefits or money that is offered is below the amount stated in the policy
- Payments to the policyholder are unreasonably delayed
- Inadequate investigations by an insurance company
Any actions that disrupt a policyholder’s right to receive proper benefits as stated under their insurance contract are considered insurance fraud and victims are eligible to seek compensation for their losses.
How Does Your Insurance Company Define “Disability?”
In many cases, whether you receive benefits depends on how your insurance company defines “disability.” LTD policies typically fall into two categories – “own occupation” and “any occupation.”
A definition of a disability in an “own occupation” policy will generally be less strict. The language likely reads something like the following:
“A disability exists when, due to an accidental injury or illness, you are not able to perform the material or substantial duties of your regular occupation.”
In this case, the disability revolves around your ability to perform your “own” job, the one you have at the time you obtain your policy. If you are a police officer and an injury or illness prevents you from handling the physical and mental requirements of the job, you will be considered disabled even if you are able to perform other, less strenuous jobs.
In contrast, the definition of a disability in an “any occupation” policy is going to be stricter. These policies generally define disability to mean that the policyholder is incapable of performing any job for which they are reasonably qualified based on their experience, training, and education. In the example above, an injured police officer may not be able to return to patrol, but they may still be able to work as a clerk in an office.
There Are Often Exclusions And Limitations
- Mental conditions. Benefits based on mental or nervous disabling conditions are usually capped at 24 months, though there are some exceptions.
- Pre-existing conditions. Most LTD policies have exclusions for pre-existing conditions that are usually defined as any injury for which you have received medical care in the previous 90 days.
- Waiting period. Most policies have a waiting period (elimination period) in which you are not covered by LTD benefits. This can be a period of three to six months and is typically the same amount of time as your short-term disability benefits.
- Duration of benefits. Some policies may pay LTD until you turn 65 and are able to obtain Medicare. Other policies will only pay for a limited number of years.
- Filing for Social Security disability benefits. Most LTD policies require you to file for Social Security disability benefits. If you are approved for SSD, your LTD policy will offset that amount to equal what they would have otherwise paid if you did not have SSD.
Can You Appeal A Denial?
The appeals process will differ from company to company, but they all have an appeals process. However, this can become complicated, and there are going to be deadlines for filing an appeal. After exhausting your insurance company’s appeal process, you could take your case to federal court.
How Much Does Long Term Disability Pay?
Long term disability benefits pay a percentage of your wages and can be increased based on cost-of-living adjustments or decreased based on other benefits you receive (work, SSDI, etc.). Most LTD policies will pay between 50% and 80% of your pre-disability earnings. These policies will typically institute a maximum that they will pay.
How Much Does An Attorney Cost?
In most cases, you will not pay any upfront or out-of-pocket costs for your case. Most attorneys who handle long term disability cases work on a contingency fee basis. This means you will pay legal fees only after your attorney successfully secures the compensation you are entitled to.
Speak With An Orange County Long Term Disability Attorney
Since 1978, the renowned attorneys at Aitken * Aitken *Cohn have helped spearhead several California insurance fraud liability decisions. Depending on the circumstances surrounding the denial of your long term disability benefits, you may be entitled to recover damages exceeding the benefits provided in your insurance policy. Let us use our extensive experience in this area of litigation to help you.
Please contact us today to speak with an experienced insurance fraud attorney who can evaluate your case FREE of charge and help you pursue the best course of action.