You purchased an LTD Policy never expecting to become disabled. It was nice to know you had it, just in case.
If you are a business owner or run a professional practice such as lawyers, dentists, doctors, investment advisers/managers, engineers, consultants, veterinarians, chiropractors, independent contractors, or other self-employed professionals, you likely purchased Long Term Disability Insurance when you started your business. You may have purchased this coverage through an insurance broker or directly from an insurance company. You might even have both group LTD coverage through an employer and additional coverage under a private or individual policy.
You might not know what disability coverage you have. That's okay.
We know you are good at what you do. We are good at what we do.
Together, we'll sort out what coverage you have and what benefits you are entitled to.
Speaking from experience as a business owner/lawyer and also from experience litigating LTD claims for professional clients with cognitively demanding jobs, when it comes to Long Term Disability Insurance, we tend to "buy it and forget it". We expect that if we need the LTD benefits they will be paid to us and the premiums we have been paying all these years, will have been well worth the cost.
We understand that our focus is always on our professional practices or businesses and on our families and not on the possibility of an illness or injury that could potentially cause us to be unable to do our work and run our business. That focus is why we have been successful but it may also be why we are at risk of serious disability, particularly with respect to invisible disabilities (such as depression, anxiety, burnout, panic, PTSD, chronic pain, immunological conditions, neurological conditions, and other difficult-to-prove disabilities). Unfortunately, disability claims for these types of conditions are often denied at the outset or terminated prematurely.
Helping Individual Policyholders is what we do.
Litigating long term disability claims that have been denied or terminated for any reason, including coverage issues and issues proving disability and loss of income, is what we do best and what we have been doing for over 20 years. It's all we've been doing.
The services we provide individual policyholders, while similar to those we offer our other clients, are specifically tailored to our clients' unique individual loss of income (LTD) policies and unique business-loss issues. We offer our individual/private policyholder clients the following services:
If you would like to discuss making an LTD or Business Interruption claim under your Individual Policy and/or your Group Policy, we can guide you through the process, providing you with guidance and recommendations to help ensure the approval of your claim.
If your claim has been denied or terminated and you would like to discuss how best to proceed, we can weigh your options and provide recommendations.
If you are late to submit your claim for benefits for whatever reason, we can assess your claim in light of the facts, evidence and law, and provide you with strategic advice on how best to proceed.
If your benefits are being paid to you but you would like to stop reporting to the insurance company and instead, negotiate a buyout of your policy, we can discuss the risks and strategize an effective approach to achieve your "divorce" from your insurance company.
If you are continuing work at a reduced capacity or if you are considering returning to work after a period of disability, we can review your entitlement to Partial, Residual and Total Disability benefits and determine how to prove your eligibility under your policy.
If you have questions or concerns about how your insurance company is assessing your claim (for example, their use of surveillance; their demand that you sign overly broad authorizations; or their requirement of your to attend an medical assessment arranged by them), we can review your claim and determine what has prompted the insurance company to use these claims tactics and how to mitigate any potential adverse consequences.
If you would like us to sue the insurance company for you for non-payment of benefits and damages resulting from the non-payment of your benefits and how they managed your claim, including the emotional and financial impact their denial/termination has had on you and your business, it would be our pleasure.
What happens if my LTD or Business Interruption claim is denied or terminated?
Although, we may not think about our LTD insurance often, knowing we have it tends to provide us with the peace of mind that should disability strike, our families, our businesses and our incomes will be protected.
Unfortunately, that is not always the case. The denial or termination of an individual disability claim (including Business Interruption) can have serious and far-reaching consequences. You will typically have the option to appeal or litigate. Not all cases are the same. It is important that you contact us immediately. "Time" is very much "Money", in these cases and the sooner steps are taken to resolve your matter, whether it be by way of appeal or litigation, the better you, your family, and your business will fare.
Why are Individual LTD (loss of income) and Business Interruption claims denied or terminated?
There are many reasons why individual disability claims are denied or terminated. The insurance company may determine that you do not meet the various definitions of disability under your policy or that you have not provided "sufficient evidence or support" to prove your claim.
In individual disability policies, there may be multiple definitions of disability used by the insurance company to assess and deny an individual’s disability claim, including “Totally Disability”, “Residual Disability” and “Partial Disability”. Often when a claim for Total Disability is denied or terminated, the insurance company has not assessed the claim under the other definitions of disability and our clients may be unaware of other potential ongoing entitlements.
Your claim may also be denied if the insurance company determines that you did not suffer a loss of income (or your business did not suffer a loss); that you are not receiving appropriate treatment; or they may determine you can work at your business, not fully understanding the functional requirements of your work/business and how your condition prevents your from performing your duties. Often insurance companies underestimate or never bother to assess what the cognitive functional requirements are of professional occupations or business owners and this may result in the denial of your claim.
Individual disability claims can also be denied on the basis of misrepresentation. Misrepresentation is when the insurance company determines that you failed to disclose your medical or financial information at the time you applied for the coverage and had full disclosure been made, the insurance would not have been offered to insure you. In assessing your claim, they will request and review records to determine if you made full and accurate disclosure of your information at the time you applied for the insurance coverage would they have insured you, and if not, your claim could be denied on the basis of non-disclosure and misrepresentation.
Claims that are denied based on misrepresentation (whether innocently or fraudulently) are complicated. We know how to pursue these claims and what information we will need, including engaging our own underwriter to prove entitlement.
When to make an LTD claim under an Individual Insurance Policy
If you are not able to work at all, then submitting an LTD claim is the clear next step. Some of our clients are surprised to learn that with individual policies, you may even be able to apply for benefits before you become "totally disabled". If you are still able to work at some capacity but you are only performing some of your duties, or if there has been a reduction in your/your business income as a result of your disability, it might be time to submit your disability claim. We can help you determine when to make submit your claim.
We can help you strategize the timing of your claims to
maximize your benefits and mitigate your losses.
If you have a progressive or degenerative medical condition, you will want to consider submitting a claim before you are completely unable to work. An early claim may allow you the financial flexibility to reduce your workload and focus on managing your condition and doing other things that you enjoy, while you can. We can help you determine when your symptoms and limitations would meet the different tests for disability under your policy and when best to submit your disability claim.
Submitting a claim too early or waiting too long can have serious consequences for your finances and for your ongoing coverage under your policy. For example, if you continue to work when you are not at your best and as a result you make errors or omissions, and potential professional liability claims could be made against you. When you stop working might also be a consideration if you are planning on selling your business.
Mulqueen Disability Law represents professionals and business owners whose disability claims have been denied or terminated by insurance companies. We have decades of experience appealing and litigating coverage and benefit disputes under individual disability and business interruption policies. We know how to correctly interpret and apply the provisions in our clients' policies in a strategic and persuasive way to leverage successful outcomes for our clients.
We treat our Individual Policyholder clients like we would want to be treated.
In a lot of ways, we're just like them.