Fighting for Those Who Cannot Fight for Themselves
The insurance industry sells peace of mind. People buy disability insurance hoping that they will never need it; that their lives will be free of the calamities that may trigger a claim. When tragedy strikes and a person is disabled and can no longer work and support his or her family, the protection is supposed to kick in.
But what happens when it doesn't? What if the insurance company will not pay? Or what if it delays the claim process to such an extent that a desperate insured feels forced to settle for pennies on the dollar?
Why insurance companies commonly deny disability insurance claims
Insurance companies rely on certain standard defenses to deny disability insurance claims, including:
- Material misrepresentation in the application
- Misrepresentations about prior medical conditions
- Refusing to take a job in "any occupation" even if it is not the same occupation that the insured had before the disability
- Disability resulting from a violation of the law
- Lack of sufficient medical documentation of disability
- Pre-existing condition exclusions
Rutter & Russin has successfully challenged disability claim denials by the biggest companies in the business. We have represented doctors, lawyers, insurance agents, and professional athletes. Now let us help you.
The insured-doctor’s health problems—primarily arthritis—were wearing him down. He cut back on his practice areas and hours, but continued to work. He never thought of submitting a disability claim because he was still working 40 hours a week, even though he had previously worked 60-80 hours per week and was no longer doing the most lucrative part of his practice. Finally, he decided to sell his practice and retire, and submitted a claim for total disability (TD) with his long-time insurer. The insurer dragged out the claim process for several years, asking for more and more documents, tests, and statements. When the doctor could not wait any longer, he sold his practice and the insurer then decided he was not TD, but had voluntarily retired. It took years of litigation, but we forced the insurer to the bargaining table and worked out a fair settlement for the doctor.
The insurance company did not believe its own insured when he told them that the drugs he was taking for his cancer treatment caused so much fatigue that he could no longer work as many hours as he used to, or earn as much money. The company argued that the treatment was successful and that his business had decreased for other reasons, such as the faltering economy, and denied his claim in its entirety. A federal lawsuit filed by Rutter & Russin established that the insured's loss of business was due to his health problems, and not any other causes, which lead to payment of the claim.
A young man's professional prospects were cut short by a devastating knee injury. Fortunately, he had had the foresight to purchase an own occupation disability policy. Unfortunately, the insurance company contended that the knee injury occurred before the policy took effect. Rutter & Russin worked with the insured's doctors to establish that the knee problem that pre-existed the policy was insignificant, and that the actual disabling event had occurred after the policy went into effect.
The insurance company did not believe its insured when he told them that he was too depressed to continue practicing law, so he turned to Rutter & Russin to help him establish his claim. Working with the insured's doctor and psychiatrist, Rutter & Russin convinced the carrier to honor the claim, resulting in lifetime disability payments to the lawyer.
A salesman admitted that his bad back did not prevent him from performing many jobs, just the sales job that he had at the time since it required him to carry and display to customers heavy items. The disability insurer did not buy the story, but it agreed to a confidential settlement once Rutter & Russin became involved and successfully argued that the policy insured the client in his own occupation, not just any occupation.
Shortly after she was hired as a local company's new human resources director, the insured was diagnosed with a severely disabling and progressive condition. She did her best to continue working, but the disease finally rendered her permanently and totally disabled. She turned to her disability carrier for help, but was abruptly shunned based on the company's determination that her condition pre-existed her employment. Rutter & Russin, working with the insured's doctors and her employer's own counsel, convinced the insurer that the treatment the insured had received during the pre-existing condition look-back period was not related to the condition that eventually rendered her disabled, but was an unrelated medical problem. The insurer agreed to pay the full policy benefits.