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Disability insurance carriers
often deny benefits for the conditions listed to the left,
insisting that the insured's subjective symptoms do not provide
objective, verifiable evidence of disability. In many cases,
there is no provision or contractual requirement mandating
that the insured submit objective evidence of disability.
Therefore, from the insured's perspective, these insurance
companies are merely trying to save money by generously interpreting
policy language in favor of claim termination. In addition,
these companies appear to be taking advantage of flaws in
medical science, which has not yet progressed to the point
of creating methodologies for objectively testing and identifying
certain conditions.
Notwithstanding the subjective
nature of a particular condition, the insured may be able
to secure or reinstate disability benefits with ample documentation
and medical records supporting his or her diagnosis, including
sufficient evidence that the insured is unable to work due
to his or her symptoms and limitations. In presenting or re-presenting
a claim for benefits, however, the insured is often at a significant
disadvantage as a result of being out of work. Insurance companies
know this and, when confronted with an individual claim for
a subjectively diagnosed condition, often take a hard-line
position, refusing to pay or negotiate, or offering a buy-out
worth a fraction of the amount of the claim. Denying a claim
or negotiating a small buyout can save the insurance company
a significant amount of money, often more than $1 million
on single policy. The best bet for insurance companies is
therefore to deny claims and, if necessary, challenge insureds
to take them to court for what are often hard-fought battles.
More recently issued disability
insurance policies have significant limitations relating to
"subjective" or "self-reported" illnesses.
For example, these policies limit the duration of payment
for psychiatric or psychological disorders, cutting off benefits
after two or three years. Insureds often blindly accept their
disability carrier's decision to deny or limit benefits based
on such conditions without considering numerous relevant factors,
including whether there are any physical aspects to the insured's
mental condition, whether the mental condition has a biological
cause, or whether another, covered condition was the legal
cause of the disability.
Disability insurance coverage
issues are undoubtedly complex, and policy language is often
ambiguous and confusing. Insurance companies take advantage
of this complexity when denying claims; therefore, it is critical
that the insured understand the legal and factual issues relevant
to his or her claim. The Firm's services include legal advice,
counseling and representation on how to traverse the myraid
of issues and problems that may arise.
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