10 More Legal Mistakes Professionals Make When
Filing a Claim for Disability (Mistake #3)

In an effort to provide professionals with more information about how the disability claims process works and identify some of the most common pitfalls for professionals filing disability claims, Comitz | Beethe attorneys Ed Comitz and Derek Funk have compiled an updated list of the 10 most common mistakes we are seeing physicians, dentists, and other professionals make when they file claims under the new post-2000 generation of disability policies (which are much more complex and stringent than the policies sold to professionals in the 1980s and 1990s).

In this post, we’ll be looking the common mistake of failing to watch out for the limitation provisions that insurance companies are adding to newer disability policies.

Mistake # 3:  Failing to Understand the Limitations in Newer Disability Policies

Professionals should carefully review their policies to make sure they understand the scope of coverage provided. An important consideration in evaluating a new policy now involves whether it imposes conditions on eligibility for benefits that conflict with those imposed by an existing policy. For instance, one policy may only pay total disability benefits if an insured is unable to work in his prior occupation and is working in another occupation (an “own-occupation” policy with a “work” provision), whereas another policy may provide benefits only if the insured is not working in another occupation (an “own-occupation” policy with a “no work” provision). Thus, if you are not careful and intimately familiar with the terms of your existing policy or policies, you can end up purchasing a new policy (and paying years of premiums) for coverage that is essentially worthless (because it is impossible to collect benefits under both policies at the same time). Some policies even have “offset” provisions that deduct the amount of benefits you receive if you receive disability insurance benefits from other sources.

It is also important to take note of limitations or exclusions in the policy that may limit recovery for certain conditions. Many policies contain limitations on benefits for disability caused by a mental illness or an illness with largely subjective symptoms that cannot be verified with objective testing. Other policies that provide for lifetime benefits may permit lifetime recovery for disabilities caused by “injury,” but place a limitation on disabilities caused by “illness or disease.”

Action Step:  When you receive the full policy, read it cover to cover and make sure you are aware of all of its terms, conditions, and limitations.

To read the rest of the 10 most common mistakes, click here.

To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.

Search Our Site