You Deserve

Your Erisa Benefits

How the insurer defines “disability” makes a difference

| Apr 30, 2021 | Bad Faith Insurance Claim Denial

An insurance agreement is a kind of contract in that two parties agree to certain actions in certain situations. If you or a loved one on your plan have a disability, either because of a medical condition or another factor, then you should have coverage. As long as the condition is actually a disability according to the language in your policy.

Policy language vs. statutory language

The most common definition cited for a disability is the one used by the Social Security Administration (SSA). But, how the SSA defines a disability is entirely irrelevant for employer-provided insurance plans. If your policy describes “disability” in a way that disqualifies you, that creates a distinctly tricky situation.

An insurer may include whatever language they wish when writing a policy around long-term disability benefits. It could consist of coverage for partial-long term disability or not. It could define disability narrowly or more generously. Ultimately, your disability claim’s status will be held against the standards set in the policy.

Up for interpretation

With any insurance dispute that comes down to policy language, there is almost always room for interpretation. Insurers typically interpret the policy as narrowly as possible. Moreover, they usually write policies that lend themselves to such narrowness.

All that said, policy language may not be the end of the matter when it comes to denied long-term disability claims. An insurer may initially deny a claim, but with intelligent, skilled ERISA law representation, you may be able to push back against the denial in court to get the benefits you deserve.