Disability Insurance: Private, Group, Association
Thursday, April 5th, 2012
Chances are, if you are reading this blog, you are either having a problem with your disability insurance, or concerned that you may be about to have a problem. Most disability insurance policies fall into one of these three categories: private, group and association. If you don’t know which one you have, now would be a good time to find out. Here’s why:
Private or Individual – purchased as an individual, often by business owners, high income professionals, or purchased to supplement other disability insurance policies. The most expensive kind of policy, as the risk is not spread out by being part of a larger group. Also likely to provide the best coverage. Legal problems can be addressed in civil court, where you have a right to recover the benefits that were not paid to you. No damage awards, no pain and suffering or hardship awards brought about by the failure of the insurance company to provide you with the benefits that are in your contract. Still, being able to go straight to court when negotiations fail can speed up the process.
Group – The least expensive, the most difficult to fight when disputes arise, and also the most prevalent. Group disability policies are part of many employee benefit packages and as such fall under ERISA, a federal law governing how disputes can be resolved. If you are paying for your disability insurance via a paycheck deduction, you most likely have an ERISA policy.
If you have an ERISA policy and your claim is denied or is being delayed, consulting with an experienced disability insurance law attorney is critical to fighting for your policy benefits.
Your options are more limited from the start in a group policy. You start with an administrative appeal, and when in litigation, typically the only materials that can be reviewed by a Judge are those that are already in your file that has been assembled by the insurer (and your claim support). If your doctor has not been creating reports and sending them to the insurance company, they have to be made a part of the file or they will NOT be considered in the review. This is where an experienced attorney can make all the difference.
Association – Professional associations offer their members disability insurance policies that are sold to the association, which then sells the policies to their members. Association policies often have a pricing structure based on age – not too expensive for younger physicians, and incrementally more expensive each decade of practice. There may be discounts, but there may be strict limits on the discounts – or they may be removed entirely at the discretion of the disability insurance company.
Waiting periods, own occ, or any occ provisions are similar to most group plans – whatever is in the policy is what you are buying. From our perspective, association policies are usually only slightly more advantageous than group disability insurance policies.
Whatever kind of policy you have, an experience disability insurance lawyer is your best protection when the disability insurance company denies or delays your claim. Call our office today to learn how we can help.