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RESIDUAL BENEFITS UNDER LONG TERM DISABILITY INSURANCE POLICIES

Wednesday, August 11th, 2010

We represent many clients regarding residual claims, a challenging area of disability insurance law where we feel our practice shines. A residual disability benefit is a disability that causes an insured’s income to fall more than 20% below its pre-disability level. This percentage varies with the policy, and some companies include a loss of time requirement or the inability to perform some duties.

One of our clients owns two private policies. This is a smart, albeit expensive, strategy that creates maximum income protection. Ideally, each policy has different features so that what one does not cover, the other will. He was being paid residual disability benefits under the first policy only. The second policy did not offer residual benefits, only total disability benefits, so he had not filed a claim.

However, over time his condition led to the loss of the use of both of his feet. He was not able to walk at all and could only work by using a scooter. He was still able to drive, but that was the only meaningful use of his feet.

He contacted us to help develop a strategy for pursuing a total disability claim under the presumptive disability portion of his non-residual policy. This policy provision allows for total disability benefits even while working in the case of the complete loss of feet, hands, eyes, ears, etc. The insurance company challenged this, claiming that our client was still driving and so he had not actually lost total use of his feet.

With skilled and determined legal research, we were able to demonstrate that the law would indeed support benefits where the insured lost all practical use of the legs.

Getting the treating doctor to support the loss of practical use was the next step in the process and we were successful with this. His support helped tip the scales in favor of convincing the insurance company to pay total disability benefits.

As a result, our client will now receive a full monthly benefit under the policy, regardless of whether or not he continues to work.

If your disability insurance policy has a residual disability benefit clause, don’t wait until your disability has caused your income level to plummet. Call our office and learn how we can help.

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Sorry, we do not handle SSDI/Social Security claims.

Frankel & Newfield does not currently handle any Social Security Disability Insurance claims.

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