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Ben Glass, Esquire
Watch Your Language!
Benjamin W. Glass and Associates
. https://www.benglasslaw.com/

Watch Your Language!

Sometimes, language in an employer's insurance policy spells trouble for people filing for long-term disability

Insurance companies always seem to be trying everything they can to keep you from getting benefits, including technical wording! Look out for this kind of language

A definition of disability that pays benefits only if you can't perform “each and every” material duty of your occupation. (In other words, “We'll only pay you if you're in a coma.”)

This language shows up in a lot of policies, and for good reason. Courts have held that this language means that you will only be paid if you cannot perform EVERY material duty of your regular occupation.

In other words, if you were a journalist, and you were not able to travel, meet with people, or type at a computer, but you could still read, then you would not be disabled from your occupation as a journalist because you could perform at least one of the substantial duties of your occupation.

In one case, the claimant was the assistant manager of the computer information systems for his company. The physical requirements of his job included using a personal computer, talking on the phone, and attending meetings. He was frequently required to stand, walk, and sit and the job could not be performed by alternating between sitting and standing. He became injured and everyone agrees that his injury limited him to doing “some sedentary work for up to three hours in an eight-hour day.”

The insurance company argued that if he could perform even one material duty (e.g., working a little bit for three hours a day) that we was not disabled and therefore not entitled to payments.

The court bought this argument.

Under the federal law of Employee Retirement Income Security Act, there is no oversight of what can be written in a disability insurance plan. Since there is no requirement that benefits be provided at all, there are no rules against providing scanty or illusory benefits.

As the purchaser of the long term disability policy, if the plaintiff's employer had wished to insure its employees against anything but the most serious and debilitating of disabilities, the plaintiff's employer could have elected to pay a higher premium for more inclusive coverage. Plaintiff's employer elected not to do so and the plaintiff is bound by the terms of the policy which his employer paid for.

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