I get Social Security disability benefits, but my insurance company isn't paying me. How is that possible?
This is possible because the definition of "disabled," "disability," or "totally disabled" in the long-term disability policy is likely (almost certainly) to be different than the definition of totally disabled according to the Social Security Administration.
Because of these different definitions, insurance companies can get away with not paying long-term disability benefits even when the government is paying disability benefits. With a different definition of disabled than the government, a disability insurance company can plausibly deny further benefits while at the same time saving itself money.
In reality, disability insurance companies use disability benefits paid by the government to reduce the amount they have to pay on the claim, and often their long-term disability policies require a claimant to apply for SSDI and any other benefits for which they might be eligible. This is not an altruistic act by the insurance company, it is done simply to save themselves money.
My insurance company wants to perform an Independent Medical Exam (IME). What is this? Are they allowed to require me to participate? Should I be worried?
Typically there is a clause in the disability policy allowing the insurance company to examine you "as often as reasonably possible." Additionally, failure to participate in an IME can result in termination of your benefits. These exams are often nothing more than a chance for the insurance company to gather evidence or reasons to deny your claim. There are companies that specialize in finding doctors to perform an evaluation of your condition and your ability to work. These companies often cater to insurance companies. In order to secure repeat business, these companies seek doctors who will provide the results insurance companies seek.
At an IME, the insurance company's expert will examine you. This exam is often coupled with a review of your medical records. These doctors often point to seemingly meaningless statements by your own doctors as "evidence" that you are no longer disabled. Our experience allows us to structure your claim to give you a better chance of avoiding problems caused by IMEs. We have ways to help you get through this stressful process.
Kerr Law, P.C.
Main Office Location:
119 Davis Road, Suite 1F
Martinez, GA 30907
Toll free: 877-631-0330
What is the difference between "own occupation" and "any occupation"?
This distinction is often made in policies, particularly group policies. Typically, for the first 24 months of being on claim, a person must be disabled and unable to perform his or her own occupation. After receiving benefits for 24 months, a person must be disabled and unable to perform any occupation for which he or she is reasonably suited by education, training and experience.
While maintaining a client who is receiving benefits under the "own occupation" provision of the policy, we always work toward making sure he or she will be able to continue to collect disability benefits under the "any occupation" definition of disability in the policy.
My insurance company is offering a lump-sum buyout, but the amount is not the same as what I would get if they paid me until age 65. Why?
Insurance companies offer lump-sum buyouts in order to save themselves money. Paying the full amount of the policy does not do that. For example, for a disabled person 55 years old receiving $1,000 per month:
$1,000/month x 12 months x 10 years = $120,000
A lump-sum buyout of $120,000 would not save them money; it makes more sense for them to continue to pay $1,000 per month until age 65, as it remains possible that you will pass away or become able to work once again, limiting the amount they would otherwise have to pay until age 65. Thus, insurance companies offer less money for a lump-sum buyout. Lump-sum buyout amounts also take into account the present value of the claim.
With our experience, we can help you determine the reasonable value of the claim and secure an amount that is fairer to you.
Contact Us Today
E-mail or call us at 706-564-7243 or toll free at 877-631-0330 to discuss your case. We can provide the reliable, experienced representation you need.