Filing a Disability Claim with Great West Disability Insurance

Great-West is an important player in the disability insurance world. Many of our dentist clients have policies of coverage through Great-West, which has provided insurance in an arrangement with the American Dental Association (ADA). These ADA group association policies have been covering dentists for many years.

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Great-West began as a Canadian insurance company in 1891 and expanded into the United States in the early 1900s. In early 2019, the disability portion of its business was acquired by Protective Life Corporation, a U.S. subsidiary of Dai-ichi Life Holdings Inc., a massive Japanese life insurance company. The acquisition was completed in June 2019.

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With the completion of the acquisition of Great-West Life & Annuity’s individual life insurance, annuity business and all of the American Dental Association group insurance plans, Protective Life is the entity administering Great-West’s American Dental Association Insurance Plan, including the disability plan. If you have a Great-West ADA disability plan, expect to receive communications from Protective Life, both by email and by hard copy.

Implications for Great-West Assurance Disability Insurance Policy Holders

Whenever another layer of corporate ownership gets added to any company, and especially a disability insurance company, we believe it is the start of a dive to the bottom for policyowners. Despite corporate wordsmithing about caring for customers and employees, the companies take a fine-tooth comb to its new acquisition, looking for places where profits can be boosted and exposure to any liability can be tightened up.

Another factor when a merger occurs is companies start looking for redundant personnel. There may be a transition time when claims departments from both companies are working side by side, and then the spotlight of the merger comes to the HR department. How many people are in claims, how many claims are processed, and is there any overlap that can be eliminated?

At this point, employees start to worry about their own job security and if performance metrics include how many disability claims are denied, delayed or terminated, that creates a host of problems for claimants. We’re not saying that every insurance company does this when there is a merger, but we’ve been around the block in the disability insurance world, and we have seen this occur more than once. It’s something we keep in the back of our minds when we are dealing with claimants whose disability insurance company has recently purchased another company or been bought out.

The Disability Claimant May Be Who Pays the Price for the New Acquisition

Great-West Assurance Company is a large insurance company that offers many different disability insurance polies to a wide span of business owners, professionals, employees and even part-time workers and home-based business owners. The company sells short and long term disability insurance policies, and Great-West markets disability insurance policies to associations as well as private and group disability insurance policies.

Great-West is well known in the dental profession, as it has a decades-long history of selling disability insurance policies, along with many other insurance policies, to the members of the American Dental Association (ADA). The company created the ADA Disability Income Protection Insurance Plan, which is only offered by Great West to ADA members. The plan includes and “own occupation” definition of disability that can pay benefits to age 67, if the claimant is disabled between ages 65 – 75 (for a 24 month period). Great West reports that 1 out of 4 dentists will become disabled long enough to collect disability benefits at some point during their careers.

Dentists aren’t the only people who purchase disability insurance policies from Great West. The company sells disability products for professionals, business owners, and employees. Policies are also offered for people with challenging occupations, including seasonal workers, freelancers, home-based business owners and new business owners.

Most disability insurance companies shy away from small businesses, self-employed people or people who work from home. However, Great-West developed a product specifically for business owners.

Great-West also has a disability insurance program for people who want to pick and choose what kind of coverage they want. We warn people to be wary of these plans, as taking a lower priced disability insurance policy often comes with less coverage. It seems like money is being saved, until a claim is made and there is not sufficient coverage for the breadwinner to pay bills.

“Regular Care of a Physician” an Issue with Great-West Disability Insurance Plans

What differentiates the Great-West Plans is how they define “Regular care of a physician.” Unlike most other disability policies, which require the claimant to be under the care of a physician, Great-West takes the definition a step further, requiring care and treatment at “such intervals and frequency as will tend to lead to a cure, alleviation, or minimization of the condition(s) causing the total disability or residual disability and which will lead to the Member’s return to the substantial & material duties of his own profession or occupation or maximum medical improvement with appropriate maintenance care.”

For example, if the claimant suffers from Carpel Tunnel Syndrome and surgery is a possibility, however, the claimant is reluctant for whatever reason to undergo surgery, Great-West could claim that failure or a refusal to undergo surgery means that the claimant refuses to satisfy the Regular Care and Treatment of a physician provision and deny or terminate the claim.

Being forced to undergo surgery in order to obtain disability benefits presents a number of legal issues, which are explored in an article written by Jason Newfield.

What Can You Do to Protect Yourself and Your Family?

Working with an experienced disability insurance attorney will make a big difference in the outcome of your claim. At Frankel & Newfield, we work closely with our clients throughout the disability claims process, from preparing medical records and speaking with their primary care physician before they file a claim, helping clients make smart decisions about when to file a claim, advising them filing the actual claim, and generally going every step of the way with them.

When claims are denied, you have the right to appeal the decision. However, the disability claim is subject to rigorous time constraints, especially if it is a group policy and governed by ERISA. Many people make the mistake of putting off responding to communications from the disability insurance company and lose the right to appeal their claim simply because they waited too long.

By working with an experienced long-term disability insurance lawyer, claimants benefit from the knowledge and skills that are needed to navigate this difficult process. They are able to focus on their illness or their injury and know that a trusted attorney is working on their behalf.

This is often the worst time in our client’s lives. Many express their appreciation to us after we have been able to secure their benefits. We are pleased to share their comments in the Testimonials section of our website.

We understand the importance of the long-term disability insurance benefit. Whether your policy is with Great-West or Protective, you can be confident that our firm will provide aggressive representation, combined with compassion about your situation. We know how dismissive and cold the insurance company can be, and how powerful it is when a blank wall seems to have been dropped down upon your life. A denied disability claim is the last thing you want to deal with when you’ve received a life-changing diagnosis or experienced a serious injury.

Jason A. Newfield

Written By:

Jason A. Newfield

Disability Insurance Attorney