Life Insurance Claims and Disabilities
Author: Attorney Lonnie Roach
Life insurance has always provided a level of comfort to those concerned about their families.
Many obtain life insurance policies to provide peace of mind to their loved ones, so they do not have to worry about final expenses. Life insurance is designed to help our families after we pass, and make the burden a little easier to bear. Unfortunately, some life insurance companies may deny you due to your disability. If you have been denied life insurance and are disabled, contact the Law Office of Bemis, Roach & Reed today.
What is Considered a Disability?
The Social Security Administration (SSA) is responsible for determining who is considered disabled for the purposes of receiving disability benefits (Social Security Disability benefits). Generally, the Social Security Administration considers you disabled if your medical or mental condition prevents you from working, or is expected to prevent you from working for at least 12 months or will result in your death. To receive these SSD benefits, you must apply with the SSA. There are many factors that are taken into account with your application. Your condition may be on the SSA’s list of impairments that are considered severe enough to prevent any sufferer from working in a substantial way. In that case, you will qualify to receive SSD benefits if your symptoms and complications meet the criteria for the specific listing. If your condition is not included on this impairment list, you can still qualify to receive disability benefits by showing your condition prevents you from working based on your age, education, work skills, and background.
Denied Life Insurance Due to Disability
Every life insurance company evaluates its applicants using different criteria. Each company will closely examine your health and disability to determine whether they will grant you a policy. It is up to the insurance company to make that determination. Your disability may be expected to last 12 months, or it may be a long term disability. Insurance companies take these time projections into account. Additionally, companies will consider whether you are getting treatment for your disability, and whether your disability will get better, get worse, or stay the same. State laws apply to the life insurance company, and you may be entitled to know why your policy application was denied. If you were denied life insurance due to your disability, you need to hire an experienced attorney to fight that decision.
In recent years, I have seen a number of wrongful denials of life insurance claims that have caused me to believe that a large number of employer-provided life insurance claims are either wrongly denied or not pursued at all because beneficiaries simply do not understand their policies.
Most employers who provide disability insurance as an employee benefit also provide life insurance.
These policies often contain a provision that waives the premium for coverage if the employee becomes totally disabled. If an employee stops working because of an injury or illness, and subsequently dies, his beneficiary should investigate whether he can make a claim for life insurance benefits.
These claims are often denied because the coverage typically ends when the employee stops working.
If the employee stopped working because of a disability, however, his coverage may, in some instances, be extended under a premium-waiver provision of the policy.
I recently represented a man who was forced to stop working due to a disabling medical condition.
When he qualified for disability benefits, his employer terminated his employment. At that time, he was offered the option to convert his group, employer-provided life insurance policy to an individual policy. The premium to do so was high, however, and because of his limited disability income, he chose not to do so. Eight months later, while undergoing surgery, he died unexpectedly. His wife made a claim under the life insurance policy, but it was denied.
According to the insurer, the husband was no longer covered because he was no longer employed and had not converted his policy to an individual policy.
I was asked to investigate and saw that, in the policy, the husband was entitled to continue his life insurance without the payment of a premium under the premium-waiver clause, and that he had up to one year to prove he stopped working due to disability. Even though the husband had already passed away, we were able to perfect his claim for premium-waiver and show that his coverage continued through the time of his death.
If a disabled person dies within one year of leaving work, it is worth the time to call an experienced Texas ERISA attorney and investigate whether a claim can be made under the employer-provided life insurance policy.
If you or a loved one has been denied life insurance benefits, please contact an experienced Austin insurance attorney today.
Call Texas Disability Lawyers Now!
The lawyers at Bemis, Roach & Reed understand that life insurance is important to your and your family, and we can help you fight a life insurance denial. If you or a loved one has been denied life insurance due to a disability, contact the Law Office of Bemis, Roach & Reed today. Do not hesitate to take the first step in protecting your family. Our dedicated lawyers will advocate for you, and will fight the insurance companies to get you the policy you need. Serving clients in Central Texas, Travis County, Williamson County, Austin, San Antonio, Houston, and Dallas/Fort Worth, our experienced disability lawyers have successfully represented numerous Texans just like you. Contact us today at (512) 454-4000 to schedule a free initial consultation.
Unfortunately, about a quarter of people will become disabled during their working years. If an injury or illness is preventing you from working, you may be eligible to collect disability benefits. If you are thinking of filing for social security or long term disability we can help. If you have filed for benefits and been denied disability we can assist in your appeal. Don’t give up. Contact the experienced long term disability attorneys at Bemis, Roach and Reed today for a free consultation. Call 512-454-4000 and get help NOW.
Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court – all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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