Has Your Disability Insurance Claim Been Denied?

If your claim for long-term disability benefits has been denied – or is denied in the future – you will need the advice and services of a California life and disability insurance claims lawyer. You should contact that lawyer as swiftly as possible after your claim is denied.

Long-term disability policies typically contain two different standards of disability: “own-occupation” and “any-occupation.” Some policies have a hybrid combination of the two.

It is important to understand the differences between the “own-occupation” and the “any-occupation” standards, as these distinctions can be confusing. Failing to understand the difference between the two standards can lead to a claim denial.

Know Your Disability Policy

It is critically important to know exactly what your long-term disability insurance policy provides. The most important provision of the policy is its definition of disability, which establishes the requirements you must meet to receive long-term disability benefits. The definition of disability varies by the policy, but it always focuses on your ability to work.

You should know that individual and group disability policies also substantially differ in their definitions of disability. Most individual disability policies do not contain “any-occupation” definitions of disability while group disability policies almost always do.

The “Own-Occupation” and “Any-Occupation” Standards.

Under an “own-occupation” standard, you are generally considered disabled if you are unable to perform the job that you were doing before becoming disabled. Most group disability policies provide that one’s “own-occupation” is based on how one’s occupation is generally performed in the “national economy” rather than how it was performed specifically for a specific employer. On the other hand, under an “any-occupation” standard, one is generally considered disabled if he or she is unable to perform any job that is realistically suited for a disability clamant based on age, education, and experience. If a disability claimant is able to work, potentially even at a lower-paying job, he or she may not be eligible for benefits under an “any-occupation” standard.

Regardless of the disability standard in your employer-provided group long-term disability insurance policy, it is important to note that you always have the option of independently purchasing supplemental coverage for added protection via individual disability insurance.

When are You Considered Disabled Under an “Own-Occupation Standard?

Under the “own-occupation” disability standard, you may be considered disabled if you are not able to perform the substantial and material tasks of the job you were working at the time you became disabled.

To prevail with a disability claim under an “own-occupation” standard, the physical requirements of your job, like walking, standing, or lifting, must be considered, and you must compile and present evidence that demonstrates why you can no longer meet those requirements.

The exact evidence you will need to prevail with a disability insurance claim will depend on the details of your job and disability, but that evidence will almost certainly include your medical records and the opinions of medical professionals who have examined or treated you. As explained above, most group disability policies have a definition of total disability that is based on how the job is performed in the national economy, not how it is performed for a specific employer.

When are You Considered Disabled Under an “Any-Occupation” Standard?

The “any-occupation” standard is more stringent than the “own-occupation” standard. Under the “any-occupation” standard, a disability claimant is considered disabled if he or she cannot perform the substantial and material tasks of any job for which he or she is reasonably qualified.

 

This can be a very complicated determination and insurers/employers must complete a vocational analysis that includes a transferability of skills analysis to determine what jobs may be available given the restrictions and limitations at issue.

Has Your Claim for Disability Benefits Been Denied?

If your long-term disability benefits claim is denied, or is denied in the future, [the skilled and knowledgeable attorneys at McKennon Law Group PC] a California life and disability insurance claims attorney can help you appeal the denial and help you obtain the benefits you have paid for and are entitled to. 

How Will an Attorney Help You?

If you purchased disability insurance privately or through your employer, and if you believe that your claim has been wrongly denied, a California life and disability insurance claims attorney can submit an appeal to the insurance company on your behalf.

If it becomes necessary, your attorney can take your case to the federal or state courts. McKennon Law Group PC has a detailed Guide on its website available for download regarding filing long-term and short-term disability claims and getting them paid.

McKennon Law Group is Here for You

The award-winning team of disability insurance attorneys at McKennon Law Group PC is ready to help. With offices in San Francisco, Los Angeles, San Diego, and Newport Beach, California and more than seventy-five years of legal experience, we advise and represent disability and life insurance policyholders and beneficiaries throughout California and the United States. McKennon Law Group PC is committed to the highest standards of client service, professional ethics, and legal excellence. If your claim for disability benefits is denied, call McKennon Law Group PC today at (949) 504-5381 for a free consultation with one of our disability attorneys,

McKennon Law Group represents clients at every stage of the disability insurance claim process, and you pay no fee to McKennon Law Group PC until we recover your disability benefits.