Long-Term Disability Insurance Claims
If you have sustained an injury or illness that prevents you from working in your occupation, you know just how difficult it is to maintain your lifestyle, to support your family, and/or to cover the overhead expenses needed to maintain your business or practice. Typically, people who come to us with their long-term disability claims are at one of the lowest point in their life. Fighting with their insurance companies to obtain what they were promised and owed is not only demoralizing, but is destructive to the individual and his or her family. We understand how important your disability claim is to you, and the importance of ensuring you are treated fairly, with dignity, and with compassion and understanding. At Adelman German, P.L.C., we help those that are disabled to recover benefits owed pursuant to the long-term disability insurance policies they were sold. We handle claims from start to finish, and will do all we reasonably can to ensure that you recover the benefits to which you are entitled. Do not wait and allow the insurance company to take advantage of your situation. Call us immediately if you believe you may have a long-term disability claim or if you think your insurance company is denying benefits to which you are entitled. We can stand up for you.
Contact us to speak with an experienced Arizona disability insurance lawyer.
Long-Term Disability Insurance Basics
At Adelman German, P.L.C., we assist disabled medical professionals and other high-level professionals and business owners to recover benefits owed pursuant to disability insurance policies purchased when they were healthy. These "private" disability insurance policies usually include "own occupation" language, and are distinguishable from policies employees enjoy through group-benefit plans offered by their employers. Our firm does not handle claims made pursuant to group-benefit plans, which are typically governed by Federal ERISA laws. On the other hand, we do handle bad faith insurance claims that arise out of an insurance company's wrongful refusal of an insurance company to pay benefits. Disability claims that initially seem straightforward can take on a life of their own and wreak havoc on professionals and their families if not handled properly from the beginning.
Here are some basic terms and concepts to consider when exploring whether you should call our firm to discuss whether you should pursue a long-term disability insurance claim and/or a bad faith lawsuit arising out of a privately purchased, non-ERISA disability insurance policy:
- Total Disability: A monthly benefit may be owed under your policy if you are unable to perform the substantial and material duties of your regular occupation. This benefit is payable sometimes even if you are able to work in the same field or industry. For instance, a neurosurgeon with a tremor may qualify for "total disability benefits" even if he is able to continue with an office-based medical practice.
- Residual (or Partial) Disability: A portion of the monthly benefit or sometimes the entire monthly benefit may be owed if you are unable to perform some of the material duties of your occupation and you have suffered a loss of earnings. For example, if you suffer back problems that prevent you from working more than a few hours per day, and your earnings drop, you may be entitled to a residual (partial) disability benefit.
- Presumptive Disability: If you lose your sight, hearing, the ability to speak, or the use of any two limbs, you may be entitled to disability benefits whether or not you are able to continue to work.
- Waiting Period: "Waiting period" is a term of art with respect to long-term disability claims. Depending on the terms of the policy, you usually have to be disabled for a certain period of time before benefits become payable. Typically, many policies provide a 90-day waiting period for disability income claims, and a 30-day waiting period for Business Overhead Expense claims. Each policy must be reviewed to determine how this term is defined.
- Business Overhead Expense (BOE Claims): Sometime business owners or professionals will purchase a separate Business Overhead Expense policy to cover certain expenses incurred by the insured while he or she is disabled. This can help bridge the gap during a period when you cannot practice, but when you or your business still incur expenses. This coverage can also be used to pay fixed expenses incurred as a result of contracts, leases, or other commitments during a period of total or residual disability.
- Waiver of Premiums: During periods of disability, and after a "waiting period" lapses, a common feature of disability insurance policies is the "waiver of premium" provision. This simply means that premiums are waived while you are disabled. We recommend you carefully read your Policy before you pay premiums while you are receiving disability benefits.
- ERISA Claims: Many employee benefits are controlled by the Employee Retirement Income Security Act (ERISA), which regulates a vast number of employee benefit claims, including long-term disability insurance claims if the benefit stems from a self-funded group policy or "plan" issued through an employer.
- Bad Faith Claims/Lawsuits: If your insurance company is acting unreasonably or in bad faith by dragging its feet, refusing to pay benefits you are owed, or failing to fairly consider your claim, the results can be devastating, especially when it comes to disability insurance claims. You may be unable to pay your mortgage, and as a result, you may lose your house, or worse. Financial strife can destroy a marriage and tear families apart. Insurance companies that take advantage of your unfortunate situations are at risk of being sued for insurance bad faith, and can be held liable for the damages you suffer, along with pain and suffering, attorneys' fees, and punitive damages. Do not allow an insurance company make you feel as though you are at their mercy. You have rights, and you should not be forced to "take on" your insurance company by yourself. If an insurance company is treating you unfairly, please contact us today online or by telephone at 602-635-1401 to speak with an experienced Arizona lawyer.
- Arizona's Unfair Claim's Settlement Practices Act (the "Act"): Arizona does not tolerate insurance companies that behave badly towards their insureds. There are statutory "guidelines" governing the conduct of insurance companies. An insurance company that, among other things, misrepresents policy provisions, fails to acknowledge pertinent communications, fails to reasonably or fairly investigate a claim, and/or fails to promptly, fairly, and equitably adjust a claim, is in violation of this Act. The failure of an insurance company to comply with the Act can lead to significant exposure.
- Lump-Sum Settlement in Exchange for Surrender: Once your claim is approved and you are receiving benefits for a length of time, your insurance carrier may offer to pay you a lump sum of money in exchange for the surrender of your policy. The amount paid is dependent on whether your Policy provides for lifetime benefits, your health, and the likelihood your disability will continue indefinitely. The amount paid is also dependent on "present day value" calculations. We would encourage you to seek legal advice from an experienced attorney before you accept a lump-sum settlement in exchange for the surrender of your Policy.
Regardless of the type of disability coverage you enjoy, your insurance company has its own interests in mind, and may try to prevent you from getting the benefits you are owed. Your insurance company may act in bad faith, or violate Arizona's Unfair Claim's Settlement Act, and/or may simply refuse to honor the terms of your insurance contract. You are much better off seeking appropriate legal advice ahead of time, before something goes wrong.
Our lawyers have extensive experience combating insurance tactics and winning cases for our clients. We carefully examine every case, and learn as much as we can about your profession, your needs, and your expectations so we can better represent you. We do not believe in a cookie-cutter approach, and we understand that your claim is unique.
Contact Our Firm Today
If you are faced with making a disability claim due to an illness, or if you have suffered an abrupt injury and are unable to work in your occupation or otherwise, please contact us today online or by telephone at 602-635-1401, to speak with an experienced Arizona attorney. Whether your benefits have been denied, or you are still preparing your initial paperwork, we can help with every aspect of your claim, so you can concentrate on putting the other pieces of your life back together. We accept clients from the Phoenix Metropolitan area, the State of Arizona, and throughout the United States.