This is a provision that requires a claimant to be under the care of a doctor in order to receive disability benefits. Initially, care provisions simply required you to be seeing a doctor on a regular basis in order to retain your eligibility for benefits. However, over time, insurance companies have made care requirements much more stringent, in an effort to dictate policyholders’ medical care and force policyholder’s to undergo unwanted procedures. So, for example, if you have a newer disability policy, your policy might add the additional requirement that you must receive the “most appropriate” care for your condition in order to keep receiving your benefits. If your policy contains such a provision, and you disagree with your insurance company’s opinion of the “most appropriate” care for your condition, you may be forced to choose between submitting to an unwanted medical procedure or going to court to resolve the dispute.
Click here for more information about the different types of care provisions and how they impact your right to make your own medical decisions.
Carpal Tunnel Syndrome (CTS)
A condition where the median nerve is pinched or compressed as it travels to the wrist. This common condition can cause pain, numbness, weakness and tingling in the hands, wrists, or forearms. It is common in professions that require repetitive motions of the wrist, such as dentistry and surgery.
Click here for more information about disability claims and unsuccessful carpal tunnel surgeries.
Chronic Fatigue Syndrome
A disorder characterized by extreme fatigue, pain, cognitive difficulties, and sleep abnormalities that are not alleviated by rest, and become worse with exertion. Symptoms cannot be explained by another underlying medical condition. Diagnosis is typically based on self-reported symptoms and ruling out similar medical conditions with objective medical tests.
Click here for more information on how subjective conditions can be treated differently and/or excluded by some disability insurance policies.
Often characterized as pain lasting three to six months, or longer. Common causes of chronic pain include arthritis, migraines, nerve damage, fibromyalgia, myofascial pain syndrome, and degenerative disc disease, to name a few.
Click here for more information on how working through chronic pain could affect your ability to collect benefits.
When you file a claim, you will need to submit claim forms to your insurer as proof of loss and eligibility for benefits under the terms of your policy. Typically, the insurer will require signed statements from you, your treating provider(s), and your employer (if applicable) at the outset, and will likely continue to require updated statements throughout the course of your claim. While some claim forms can be found online, insurers have recently started requiring that policyholders request the forms over the phone, so that they can conduct impromptu interviews that catch many policyholders off-guard.
Click here for more information on what to expect when filing a disability claim.
The claims department’s role is to process and pay legitimate claims. When reaching a claims decision, the claims department is not supposed to consider company profitability.
Click here for more information about the four major functions of an insurance company.
Consequential damages is a legal term that, in the context of a disability insurance lawsuit, refers to the financial harm to the insured that results from the insurer’s denial or termination of benefits.
Cost of Living Adjustment (COLA) Rider
A cost of living rider is a policy provision that periodically increases the disability benefit amount to account for inflation and increased living costs. The amount of the increase can be determined by a fixed percentage or governed by the Consumer Price Index. Typically, the adjustment is made every twelve months.
Click here for more information about COLA riders.