Attorneys Long Term Disability Insurance Claim Denials  

What happens when an attorney is denied a disability insurance claim – one they filed themselves as this process was thought to be straightforward?  Often, the attorney thinks they’ll be able to represent themselves with the initial claim, like an auto or home insurance claim.  They learn fairly quickly that a disability claim is not as simple as a health insurance claim. 

Many of our clients are attorneys, and some have even been insurance attorneys, whose claims for disability insurance benefits have been denied, or even terminated after being paid for some time.   They contact us when it becomes apparent that a disability claim is more complex than anticipated, and when they experience the difficulties presented by an insurance company making the claims process difficult, if not impossible, to manage.   Attorneys at large firms likely have both a group ERISA LTD policy and a private policy to cover their earnings.  Often, these policies will need to managed together.

Jason Newfield, Esq. has represented many attorneys who have tried and failed to represent themselves in long term disability insurance disputes.  Disability insurance law is a complex practice area of the law, combining contract law, federal litigation, health law and employment law.  It also requires a sophisticated understanding of the medical issues, diagnostic testing, and occupational/vocational analysis of the lawyer’s profession. Newfield Law Group clients benefit from more than two decades of experience in disability insurance claims law.

Why Does a Practicing Attorney Need a Disability Lawyer? 

A land use and zoning attorney is wise not to take on a criminal matter. Lawyers, like physicians, are specialized and know it’s best to rely on experienced attorneys in their own practice area. The disability insurance company is just as likely to deny a claim from an attorney as they are a claim from a physician. Here’s why:

Any professional with a high income will be costly for the insurance company. An individual with several different policies, especially if they are from the same insurance company, could expose the disability insurance company to $10 million in losses. It costs the insurance company nothing to deny another claim.

Generic vocational or occupational evaluations will be used to portray the lawyer’s job as a sedentary one. Few attorneys today spend their entire careers sitting at their desks. They travel to meetings with clients, go to court (sometimes in other states), meet with experts, inspect properties, and conduct business out of the office or the home office.   Some cases have refused to consider the extensive nature of a trial lawyer, opting to view this insured as simply a lawyer – a position rejected by a Court.

For someone with a severe back injury, being able to sit at a desk and concentrate without being distracted by pain or the side effects of strong muscle relaxants and/or pain medicine is a real disability.  The insurance company MUST consider a lawyer’s ability to think clearly, make decisions, multi-task and work long hours.  The denial will come from not having substantial diagnostic tests or a physician report confirming not just the injury, sickness and resultant suffering of symptoms, but the reasons the attorney cannot perform the material and substantial tasks of their occupation.  Careful consideration must be provided into how to support your claim.

Cognitive disabilities are of particular concern for a profession that relies on the attorney having a high level executive functions with the ability to think, reason, read, write, and speak. An attorney suffering the after effects of a stroke may fully or only partially regain their cognitive function. The disability insurance company is likely to deny the claim on the basis that some stroke victims are able to return to their daily lives, disregarding the high level of functioning necessary to practice law.   Often, cognitive testing can be secured to help to support these claims.

Musculoskeletal disabilities are nearly a third of all long term disability claims when combined with connective tissue disorders and conditions. Neck and joint pain, as well as muscle and tendon problems can make traveling to and from the office, attending meetings, travelling to court, and conducting the labor-intensive work of being an attorney, difficult, if not impossible, to do. While back pain, degenerative disc, arthritis, and rheumatism are thought of as diseases striking predominantly older people, they occur at any age.   Lawyers are not immune to these issues.

Mental and Nervous Conditions are another type of disability seen with some frequency among professionals with highly stressful occupations, including attorneys.   We have represented many lawyers from large firms who are simply mentally exhausted from the pressures, and lack of rewarding environment. Most mental and nervous conditions are red-flagged by claims adjusters and medical reviewers. They are considered subjective conditions, not typically verified by diagnostic tests. Our firm has relationships with national medical experts who we utilize to establish robust diagnostic reporting for mental and nervous conditions as this is a pivotal point for claims.

Long term disability insurance companies may also attempt to negotiate a settlement with an attorney before litigation begins. The insurance company is counting on the attorney not understanding the full value of their disability insurance policy. We handle settlements on a regular basis and are accustomed to the tactics used to minimize the value of the policy. 

The settlement or buyout negotiations should not begin until you and your long term disability insurance attorney have a full understanding of the value of your claim. Every policy is different, but there are key questions to be asked in all cases: 

  • What is the value of your policy in today’s dollars?
  • What would you receive if the policy were paid until the end of coverage?
  • What do you intend to do with the money resulting from a settlement?
  • Are there other factors to consider, like the financial well-being of the insurance company?
  • What is your realistic life expectancy? This is a hard question to discuss but is important.

Once a settlement has occurred, there will be no further payments from the policy.   Other coverage may be implicated as well.  However, there will also be no further worries about the policy being terminated, investigators conducting surveillance or claims adjusters contacting the claimant for additional information or harassing doctors. 

Attorneys with disabilities should also consider the possibility of making a partial claim or what is known as a residual claim. Again, this depends upon the specific long-term disability insurance policy and its provisions, but in many cases, it is possible to utilize the disability insurance as a means of replacing income if the attorney is able to work but not at their full capacity.

A residual claim requires negotiations to get the right balance of disability benefits and work responsibilities. This will be different for an associate, junior partner, or equity partner. The long term disability claims adjuster will not be versed in the structure of a law firm, regardless of its size, and is not likely to be realistic about the workload of an attorney at any level. This is where an experienced disability insurance attorney can make the difference between a highly stressful situation and one that is handled on your behalf.

If you are an attorney considering filing a long term disability insurance claim, or if your disability insurance claim has been denied, call the Newfield Law Group at (877) 406-7883 to speak with founder Jason Newfield and learn how we can help.