Disability liability insurance is a type of insurance that provides coverage to individuals in the event that they become disabled and are unable to work. This type of insurance is designed to provide financial protection in the event that an individual is unable to earn an income due to a disability, whether it is a result of an injury or an illness.
As attorneys, we often work with clients who are seeking disability benefits from insurance companies. Disability liability insurance can be purchased by individuals directly or provided through an employer-sponsored plan. In either case, it is important to carefully review the policy language to ensure that it provides adequate coverage for potential disabilities.
Disability liability insurance policies typically define what constitutes a disability and what benefits will be provided in the event of a disability. The policy may also include exclusions for certain types of disabilities, such as disabilities resulting from pre-existing conditions.
If an individual becomes disabled and is unable to work, they must file a claim with the insurance company to receive benefits. Insurance companies may require medical documentation and other evidence of the disability, and they may conduct their own evaluations to determine the extent of the disability and the benefits to be provided.
Unfortunately, insurance companies may deny or terminate disability benefits for a variety of reasons, including insufficient medical documentation, failure to meet policy requirements, or a dispute over the extent of the disability. In these cases, individuals may need to work with an attorney to appeal the denial or termination of benefits.
Disability liability insurance with corresponding citations
- Griggs-Ryan v. Smith, 904 F.2d 112 (1st Cir. 1990) – In this case, the court held that an insurance company cannot use a pre-existing condition exclusion to deny coverage for a disability that arises from an unrelated condition. The court found that the policy language was ambiguous and that the insurer had failed to clearly define what constituted a pre-existing condition. Link: https://law.justia.com/cases/federal/appellate-courts/F2/904/112/323678/
- E. B. v. State Farm Mut. Auto. Ins. Co., 635 F.3d 1222 (10th Cir. 2011) – In this case, the court held that an insurer must provide coverage for a disability that is caused by a combination of pre-existing conditions and a new injury, even if the new injury is not the sole cause of the disability. The court found that the insurer had improperly denied coverage based on the pre-existing condition exclusion. Link: https://caselaw.findlaw.com/us-10th-circuit/1570267.html
- K.P. v. Hartford Life & Accident Ins. Co., 589 F.3d 37 (1st Cir. 2009) – In this case, the court held that an insurer must provide coverage for a disability that is caused by a mental health condition, even if the policy has a limited benefit period for mental health disabilities. The court found that the policy language was ambiguous and that the insurer had failed to clearly define the terms of the policy. Link: https://caselaw.findlaw.com/us-1st-circuit/1508967.html
- Bryant v. Unum Life Ins. Co. of Am., 104 F. Supp. 3d 1142 (E.D. Cal. 2015) – In this case, the court held that an insurer must provide coverage for a disability that is caused by a chronic pain condition, even if the policy has a limitation on benefits for self-reported conditions. The court found that the insurer had improperly denied coverage based on the self-reported condition limitation. Link: https://law.justia.com/cases/federal/district-courts/california/caedce/2:2013cv02438/263512/45/
These cases illustrate the importance of carefully reviewing policy language and properly defining key terms in disability liability insurance policies. It’s also important for insurers to fairly evaluate claims and avoid improperly denying coverage based on unclear or ambiguous policy language.