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Professional Disability Insurance Claims: The Necessity for a Proactive Approach

Beginning in the 1970’s, insurance companies began aggressively marketing specifically tailored disability insurance policies to executives, physicians, dentists, and other highly educated and successful professionals. With attractive offers of low monthly premium payments and high benefit payouts, many professionals purchased these disability insurance policies for a lifetime of protection. Due to a financial and philosophical shift in the insurance industry during the 1990’s, these professional disability insurance policies became poor investments for insurance companies, and carriers who entered into agreements are now looking for any opportunity to deny claims and terminate coverage.

The Problem with Professional Disability Policies

When faced with a disabling injury or condition that prevents a highly educated and skilled professional from continuing to practice their profession, the benefits owed to them under the professional disability insurance policy are an invaluable asset. In many cases, the benefits paid out to the insured under the policy amount to many hundreds of thousands of dollars paid over the remainder of the insured’s lifetime. As a valuable asset, the professional disability insurance policy and claim should be carefully protected at every stage of the process.

With high dollar benefit payouts, professional disability insurance policies present problems for insurance companies, so all claims are closely scrutinized for opportunities to reduce or deny coverage. Insurance companies are a leading employer of the highest skilled attorneys in the business who understand how to review disability claims and find reasons to deny coverage. When faced with the resources of an insurance carrier, it is important to have an experienced attorney to defend the protections offered under the professional disability insurance policy.

Professional Disability Insurance Claim Denial

Countless legitimate disability claims are regularly denied, and, while some of these denials may be valid, many are a product of poor decisions on the part of the insured or the direct result of claims handlers not understanding the policies and lacking proper training when making the decision to deny coverage. Oftentimes, issues resulting in a claim denial can be prevented with the assistance of an experienced attorney. Insurance companies frequently deny claims for three main reasons:

  • Definition of Disabled – Insurance companies commonly claim that an insured is not disabled under the definition of “disabled” provided within the policy because the insured can still perform a portion of their occupational duties.

Advocate Law Group regularly prepares disability claims that fully inform the claims handler that the insured is not capable of performing the essential duties of the profession, and thus must be found to be disabled under the terms of the policy. This proactive approach makes it much more difficult for claims handlers to deny coverage without clearly violating their duty to the insured under the professional disability policy and results in bad faith conduct.

  • Change of Occupation Prior to Filing Claim – This is one of the most common preventable errors that result in the denial of a disability claim. Changing occupation in order to accommodate a disability will result in denial of coverage because the insurance company only compares the insured to the duties of the current occupation at the time the disability claim is filed. For instance, a cardiovascular surgeon becomes disabled due to the loss of an arm and is unable to perform his or her duties. Due to the immediate need to continue to practice and generate an income, the surgeon transitions to the general practice of office cardiology before filing his or her disability claim. By transitioning into another occupation to better accommodate the disability, the surgeon is allowing the insurance company to show that the insured is capable of fulfilling all of the duties of the current position, and therefore they deny coverage.

Advocate Law Group works closely with clients to develop individualized strategic transition plans that allow clients to earn income while also preserving their disability claim. The attorneys at Advocate Law Group take the time to understand your specific occupation and provide counsel to professionals at the most critical junction of their career.

  • Failure to Cooperate with the Investigation – After filing a claim with the insurance company, claims handlers will begin an investigation of the injury or condition causing disability. During this investigation, the insurance company will request documentation of the condition as well as financial statement from the insured, often looking through any and all documents in order to discover a reason to deny coverage

Advocate Law Group has extensive experience dealing with disability claims, investigators, and claims handlers. By seeking representation, advice, and counsel from an experienced attorney you will be able to comply with the investigation while also protect your privacy as well as your interest in the disability monies owed to you.

Because of the large number of denials of legitimate professional disability insurance claims, it is essential to seek the advice of an attorney as early as possible in the disability claims process. The attorneys at Advocate Law Group have decades of experience taking on insurance companies and fighting for the insured. Advocate Law Group was founded on the combination of Robert K. Scott’s 36 years of experience representing clients against insurance companies and Gerry H. Goldsholle’s decades of insider’s knowledge as the Assistant General Counsel, business executive, and CEO of an arm of one of the nation’s largest insurance companies.

Advocate Law Group knows how to get insurance companies to approve claims. If a legitimate claim is improperly denied, they have a proven history of knowing how to beat insurance companies. Insurance companies know and respect Advocate Law Group. As soon as you suspect that you may not be able to perform the duties of your profession, act immediately in order to best preserve the benefits you rightfully deserve under your professional disability insurance policy.



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