Serving Pennsylvania & New Jersey
Individual Policy for Short or Long Term Disability:
If you are self employed or your employer does not provide disability insurance benefits, you can obtain your own “individual” policy. Individual rates (i.e. premiums) are based on a wide variety of factors, including age, gender, health risks, pre-existing conditions, occupation, scope of coverage, benefit duration, and benefit amount. These policies are individually underwritten private disability policies, and are NOT governed by ERISA but by traditional state contract law.
Individual disability insurance policies are basically insurance “contracts”. There are individual policies (purchased by you as an individual) and group policies (coverage supplied as an employee
benefit by your employer). Policies are written for short term disability benefits (usually 3-6 months) and long term disability benefits (usually after a waiting period and continuing to age 65). If you have individual disability insurance coverage through your employer, you have the right to obtain a copy of the policy from your employer’s benefits department.
Litigation can either be in state or federal court. Individual disability litigants have the leverage of a potential bad faith claim, the right to traditional discovery and a jury trial. Frequently, insurers are very willing to discuss a lump sum buyout of either a contested or open claim.
Filing a Disability Claim
If you think you may be eligible to file a claim for benefits under one of these types of policies, there are a few things you should keep in mind:
- It is often beneficial to get advice from a disability attorney before you apply. This could save a lot of time and frustration right from the start.
- You will need the support of your doctor(s). Make sure your doctor will support you and is willing to comply with documentation requirements of the insurance company before applying for disability benefits.
- Make sure that your treatment notes truly reflect the nature of your symptoms and functional limitations. It is very important to tell your doctor exactly how you are feeling at each and every visit.
Insurance Company Denials
Also, just because you think you qualify for disability benefits, the disability insurance companies will typically deny your initial submission. 90% of all claims are denied on the first go-round. However, even if your claim is denied, you still have the right to an appeal. It’s unfortunate, but the appeal is typically an internal review with the same insurance carrier that denied the claim initially. For this reason as well, it’s best to contact a disability attorney immediately. Appeals are difficult, but often successful if there is active support from your doctor(s) and a disability attorney. If your appeal to the insurance carrier is denied, you may still have the right to appeal to the courts.