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  • Enforcing a disability policy

    I'm a surgical subspecialist and have unfortunately been diagnosed with a rare medical condition that in the next five years will likely prevent me from operating. Luckily from what I've researched it shouldn't affect many other aspects of my life.

    There has been a lot of discussion on WCI blog and book about which policies to purchase; however, I haven't found much on the best way to proceed to make sure the policy is enforced. I have a Guardian true own-occupation policy I purchased as a resident for which I've maxed out my future increase options. I also work for a large hospital and have a group modified own-occupation policy. Together if both pay I would actually make more than I do now and be in a lower tax bracket. However, I like what I do and am in no rush to stop unless I or my doctors feel it isn't safe.

    I'm in the delicate situation where I want to make sure both policies will be enforceable but I don't want to file a claim on them until I feel I ethically can't do my best job. I have spoken with two disability lawyers to look over my policies but neither will do so as they only work on a contingency basis. I am hoping someone in the forum will have either practical advice or a recommendation of a specific law group/attorney. Any input on this situation would be appreciated!

  • #2
    I am not a disability attorney but I can offer some fundamental considerations to your question as it relates to your individual Guardian policy.

     

    Were you diagnosed with the condition after the effective date of your individual Guardian policy? If so, then you will be covered.

     

    If you were diagnosed with the condition before you established the policy, and it was not disclosed on the application, then any claim due to the condition within the first 2 years of owning the policy can be denied. It is also possible that a claim due to the condition may be denied beyond the first 2 years if it can be proven that not disclosing the condition was a fraudulent omission.

     

    You didn't mention anything about having an exclusion for the condition on your Guardian policy, so I am guessing the diagnosis occurred after you established your Guardian policy.

     

    To speak even more generally, the claims process of individual policies is less burdensome and more straightforward compared to employer provided group LTD plans. Without closely examining your group LTD plan, I would surmise that your Guardian policy is much more likely to pay a claim.

     

    I hope that helps.

     

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    • #3
      Hi Slow and Steady:  I'm a long term disability insurance lawyer who does represent clients on an hourly basis.  I'd be happy to evaluate your policies and discuss your situation with you.  Evan.

      Evan Schwartz

      Schwartzlaw P.C.

      www.schwartzlawpc.com

      [email protected]

      212-608-5445

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      • #4
        Wanted to follow-up on this situation as I have seen it come up a bit on WCI forums. Frequently I see WCI readers who are filing for disability write that they will do the paperwork themselves and only if they run into a problem will they then hire a lawyer. From my experience it is essential to hire a lawyer before filing for disability on a 100% legitimate claim. This is one of those situations where lack of experience really has the potential to change an outcome. For example, when one files a claim, an insurance company can directly contact the physician who signed the disability forms. It seems the insurance companies are known to conduct these interviews in a very aggressive manner. When you retain a lawyer experienced in physician disability cases, one of the first tasks they perform is to make sure all corrospondence with the treating physicians go through the lawyer. This is one thing I personally would have never have known to do.

        While I'm sure there are a number of lawyers experienced in physician disability, I have had a very positive experience with Evan Schwartz and his firm (https://schwartzlawpc.com/). I have found them to be on the ball, proactive and straight shooters. In addition they can work on an hourly as oppossed to a contingency basis. Just my two cents.

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        • #5
          Thanks for sharing.

          Collecting on disability is just like making a homeowners or auto accident claim.  The adjuster's job is to find any reason or excuse not to pay.  No matter if the conversation is friendly or they're grilling you, they are going to be looking for you to slip up and say something that they can use as grounds for a denial.  They will sound like your best friend, just making friendly conversation, but next thing you know something you say or the way you say it means you're not getting paid.

          Hourly rate seems like the way to go for an attorney for disability claims.  Sending the attorney a cut of your check every month sounds pretty horrible.

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