Disability Claims

Although private disability insurance policies are often costly, many people in a range of professions and occupations purchase them and pay premiums faithfully for peace of mind and income protection.

People who purchase disability insurance may have heard these alarming statistics, gathered from the Council for Disability Awareness:

  • Only 48% of Americans have enough savings to cover three months of lost income;
  • Over 50 million US workers lack disability insurance;
  • A quarter of current 20-year-olds can expect to experience at least a year of disability before retirement;
  • Medical bills, job loss, and illness are the top causes for people filing bankruptcy;
  • From 2006 to 2015, only 34% of applicants to Social Security Disability Insurance (SSDI) received approval; and
  • The average SSDI benefit in 2018 was just over $1,000 per month.

However, disability insurance does not always come through for an injured worker. When a covered individual becomes legitimately disabled by injury or illness, all too often the insurer finds a way to deny the claim — intentionally depriving that person of benefits he or she thought were guaranteed.

​Our disability insurance claim denial attorneys have the knowledge and skill to fight an unfair decision on your behalf. We encourage you to contact our disability insurance law firm for the legal help you need to:

  • ​Determine whether your claim denial is based on a legitimate reason, resulted from a mistake, or may constitute actionable insurance bad faith
  • Build a well-constructed case for payment of your disability insurance claim and, often, additional damages if we can demonstrate that insurance bad faith was a factor

If you would like to learn more about disability insurance law, keep reading.

Types of Disability Insurance

When you purchase disability insurance, you may not understand the complicated policy language. A disability claims attorney can help you comprehend your policy to understand what the company owes you.

There are different types of disability insurance, providing various degrees of benefit.  Depending on your specific policy, you may have one or more of the following types of benefits.

Total Disability 

Total disability grants the policyholder the maximum monthly benefit described in the policy. A policyholder becomes eligible for total disability benefits if they can’t work at all.

Residual Disability

Residual disability benefits apply when a person is able to do some work but can’t continue working at the level they did before they became disabled. In this situation, the policyholder receives a portion of the maximum monthly benefit described in the policy. 

Own Occupation

​“Own occupation” disability insurance provides continued income if a person is disabled and cannot continue to work in a specific field. Generally, people in highly compensated fields like medicine or athletics choose this type of insurance. However, some people in highly compensated fields think only of death, not disability. These people may purchase a pricey life insurance policy but forget to buy “own occupation” disability insurance.

Any Occupation

What is “any occupation” disability? These policies pay only if the insured cannot work in any job because of their injury or illness. For instance, a surgeon who becomes blind but retains the ability to bag groceries would not qualify for disability payment on an “any occupation” policy.

Short-Term Disability

Short-term disability generally pays for only a short amount of time, such as two years or less. If you suffer a catastrophic injury that leaves you permanently disabled, such a short window for disability payment is not very helpful.

Long-Term Disability

Long-term disability insurance pays for much longer than short-term disability. Long-term disability policies may cover anywhere from a few years to a lifetime of disability payments, depending on your policy.

Age Limits 

Some disability policies guarantee coverage for a lifetime while others do not extend coverage past a certain age, such as 65.

Social Security Disability Claims

Social Security pays disability claims for workers who sustain serious injury, illness, or death. The worker’s illness or injury must be expected to keep them out of work for at least a year for Social Security disability insurance (SSDI) benefits to be approved.

To apply for Social Security disability benefits in Texas:

  • Apply online at the Social Security Administration site, ssa.gov;
  • Apply by phone with Social Security customer service at 1-800-772-1213 (TTY 1-800-325-0778); or
  • Apply in person at your local Social Security office.

After you apply for SSDI, officials will review your claim. Eventually, you may be called in for a Social Security disability hearing. There are eight hearing offices in Texas, so you should be assigned to an office within driving distance.

Though SSDI was designed as a safety net for disabled workers, it’s not always easy to access. Here are some statistics that reveal the challenge of claiming SSDI in Texas:

  • The average SSDI applicant waits 13 months for a hearing;
  • Processing time for a SSDI claim usually exceeds 400 days;
  • Social Security approves only 38% of SSDI applications;
  • Social Security denies 41% of SSDI applications;
  • Social Security dismisses 21% of SSDI applications; and
  • Texans receiving SSDI include 3.8% of the state population.

You can represent yourself at a SSDI hearing, but it’s always best to have an attorney. At the hearing, your attorney can present your case persuasively. 

Your attorney will also know what questions and objections to expect and can prepare for them. For instance, the Social Security Administration may have a vocational expert testify that you can still work. Your attorney knows how to question the expert to counter that theory. Your disability attorney also knows how to question medical experts so that facts most favorable to your claim are brought before the judge. 

Call an attorney as soon as you receive notice of a SSDI hearing in order to prepare your most effective case.

When to Sue for Government Disability Claims

When you’re disabled, it can be confusing to determine which government disability program is best for your needs.The US government provides nine sizeable disability programs:

  • Social Security Disability Insurance (SSDI), 
  • Supplemental Security Income (SSI),
  • Medicare,
  • Medicaid,
  • Workers’ Compensation,
  • Black Lung,
  • VA Disability Compensation Program,
  • VA Pension Program, and
  • VA Health Services Program.

Each program has a different application process, and each usually has more applicants than funding. This means that you may find your legitimate disability claim denied. Here are a few reasons why the government may deny your claim:

  • You make too much money,
  • You’re not severely disabled,
  • You won’t be disabled for more than a year,
  • Your contact information is not accurate,
  • You don’t make scheduled doctors’ visits,
  • You don’t follow doctors’ orders,
  • You are dependent on illegal drugs or alcohol,
  • You have a criminal record, and
  • You lied to obtain disability benefits. 

If your disability claim is denied, you have the right to appeal.

To file an effective appeal, it’s best to hire an attorney. It can feel intimidating to go up against a big government agency on your own. A disability attorney can thoroughly evaluate your claim, identify points of dispute, and try to convince a judge to rule for you on appeal. Contact an attorney immediately so that you can work together to create your best argument on appeal.

A Record of Effective Representation for Disabled Professionals and Workers

Disability insurance claim denials are a key focus area for our disability insurance attorneys because the stakes are typically very high and violations of insurance bad faith law are unfortunately common.

In fact, our track record includes obtaining one of the largest settlements ever for a dentist victimized by a wrongful disability insurance claim denial.

If you hire our firm to advocate for your insurance claim, we will first determine what caused your denial. The insurance company may have denied your claim based on:

  • A legitimate reason, 
  • A mistake of fact, or 
  • Bad faith

We handle investigations and litigation involving:

  • ​“Own occupation” disability insurance — purchased to provide continued income if a person, typically a highly compensated professional, is disabled and cannot continue in the specific field of medicine, for example, or athletics
  • “Any occupation” disability insurance — applicable when the covered individual is injured or becomes ill and rendered unable to work any job

Next, we will build a well-constructed case for payment of your disability insurance claim. We will pursue additional damages if we can demonstrate that insurance bad faith was a factor.

Getting Legal Help Is the First Step

Are you a covered individual that has recently become disabled? With disability cases, insurance companies oftentimes give clients the run-a-round. 

If you’re wondering, Are there disability insurance lawyers near me? The answer is yes! At The Johns Law Firm, we specialize in helping our neighbors in the Gulf South.

You may need help navigating the disability claims process. Also, you may need continued legal support even after your claim is approved because insurance companies continue to monitor you while you receive disability payment. The insurance company may cease your disability payouts if they determine you are ineligible at any point.

If you think you have experienced an unfair disability insurance denial, contact us today to schedule a free consultation with our disability claims attorneys.