Fibromyalgia

Chronic Fatigue Syndrome

Sleep Apnea

Paresthesia/Dysethesia

Carpal Tunnel Syndrome

Myofascial Pain Syndrome

Lyme Disease

Orthopedic Conditions

Temporal Lobe Phenomenon

Migraine

Irritable Bowel Syndrome

Psychological and Psychiatric
Conditions

Anxiety Disorder

Post-Traumatic Stress Disorder

Depression

Bipolar Disorder

Drug and Alcohol Dependency

Osteo and Rheumatoid
Arthritis

Generalized Pain

Epstein-Barr Syndrome

Valley Fever


 


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.

 
Edward O. Comitz, Esq. · 2901 North Central Ave., Suite 1000 · Phoenix, Arizona 85012 · (800) 847-9094 Disclaimer