Why Long-Term Disability Insurers Say “No”

A long list of reasons to say no…….

There is, sadly, a long list of all of the reasons why insurance companies deny or underpay a claim.  They don’t always simply say okay, we’re going to send you to an independent medical examination and our doctor is gonna conclude that he disagrees with your treating physician. It’s not always that simple.  Often, it has to do with a sophisticated analysis of one’s occupational duties. Sometimes it has to do with performing your duties simply not as well as you used, not as fast, not as efficiently but that may render you disabled, nonetheless.   

In one case, a court reporter could not keep up with the pace with the testimony of the witnesses in the judge’s courtroom anymore because she had very serious injuries to her wrist.  She could and would work for an hour or so at top efficiency but then the pain would kick in and she’d have to slow down. As a result, court proceedings would be interrupted and slow down,  her growing disability caused a host of problems in the regular running of that particular courtroom.

So the insurance company requested a list of the court reporter’s substantial, material duties. So the court reporter sat down, wrote out a list of what her substantial, material duties were and they included: being able to process the information that she had obtained in court, summarize it, put it together in a transcript and file it with the court of appeal in a case that was going up on appeal.  So, naturally, the insurance company said, well you can do all of that so you’re not disabled. However this conclusion ignores the fact the her to day to day productivity was not meeting the demands of the daily courtroom pace, as her job requires, though she could do all of her duties generally over time. It’s a practice by insurance companies called “scoping.”  You can still do that and that’s one of your substantial material duties and therefore you’re not totally disabled, you’re partially disabled. However, as I’ve written elsewhere, partial long-term disability doesn’t really exist in California.

It was explained best by her boss,  the superior court judge who testified at her disability claim trial as follows:  he told the jury look, if you’re a musician, if you’re a violinist and you can no longer play the violin but you can still read the music you’re totally disabled, not partially disabled. “ Need less the say, the jury  looked at each other and they got it immediately.  

This is pretty typical of the way insurance companies look at things and the way that they want to view things so that they can underpay claims and save money for the insurance company, making a partial disability argument which results in no disability benefits being paid on the claim.

Before You File Your Long Term Disability Claim

How to Talk Back to Your Insurance Company

When To Contact A Long Term Disability Attorney

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