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Tag Archives: own occupation

USA Today Publishes Article—Why millennials should consider disability insurance

Posted in: Disability Insurance, Insurance Litigation Blog February 08, 2019

On January 29, 2019, USA Today published an article, “Why millennials should consider disability insurance,” by Robert Powell.  The article argues for the importance of purchasing disability insurance at a young age, since most insureds are left with the financial strain of not having a stable income stream after disability.  These insureds often never consider purchasing disability insurance, or think they have enough coverage.  At McKennon Law Group PC, we see the impact of the denials of our client’s benefits every day, and fight to overturn the denial decisions of insurance claims our clients expected insurance companies to pay upon becoming disabled.  As we have seen, purchasing additional private disability insurance can prove to be crucial.

The article describes how …

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If You Must Miss Work Two Days a Month Due to a Disabling Condition, Are You Precluded from Working in Any Occupation Under a LTD Policy?

Posted in: Disability Insurance, ERISA, Insurance Litigation Blog, Policy Interpretation December 19, 2018

Facing a long-term disability (“LTD”) claim, ERISA plan participants under LTD policies can count on the fact that insurance companies will search for ways to escape payment of the monthly LTD benefits they promised their insureds.  These insurers often point out that insureds continue to work in their occupation between their initial diagnosis and the claim date, or that an insured’s job is sedentary and thus he or she is not precluded from performing light physical activities, or that an insured’s disabling condition is episodic and the symptoms do not render the insureds continuously disabled.  Most disability claimants have days where symptoms are better than others and therefore they cannot work continuously in any given month, missing several days of …

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Sitting: If you are Unable to do it, are you Totally Disabled Under a Long-Term Disability Policy?

Posted in: Disability Insurance News, ERISA, Insurance Litigation Blog, Policy Interpretation August 03, 2018

While most people tend to have a common-sense view of what it means to be disabled, under long-term disability (“LTD”) policies, an insured must satisfy the terms of a disability policy and its specific definitions of “disability” to receive LTD benefits.  Within the first two years of a disability claim, “disability” in a policy is normally defined as the inability to perform the essential duties of one’s own job. Thereafter, “disability” is usually defined as being prevented from performing one or more essential duties of any occupation for which an insured is qualified by education, training and experience.  This “own occupation” versus “any occupation” analysis is the source of a substantial amount of judicial opinion.

Insurance companies typically argue that

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ERISA Administrator Must Show That a Theoretical Job Actually Exists in Order to Serve as Justification for Claim Denial

Posted in: Case Updates, Disability Insurance, Disability Insurance News, ERISA, Insurance Litigation Blog March 10, 2014

A common justification for denying a claim for long-term disability insurance benefits or short-term disability insurance benefits is that the claimant is capable of returning to work in another job.  However, insurers / ERISA administrators are not allowed to deny a claim just because an insured might be capable of returning to any job, rather the identified job must be based on the insured’s education, training and experience.  Further, the occupation must be “gainful,” which usually means that it pays the insured at least 50%-60% of his or her pre-disability income.  In Kennard v. Means Industries, Inc., 2014 U.S. App. LEXIS 2846 (6th Cir. Feb. 13, 2014), the Sixth Circuit imposed another important requirement — the insurer must prove …

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MetLife Cannot Require an IME After Failing to Comply with ERISA Deadlines Following a Remand of Disability Claim

Posted in: Case Updates, Disability Insurance, Disability Insurance News, ERISA, Insurance Litigation Blog March 06, 2012

In Kroll v. Kaiser Foundation Health Plan Long Term Disability Plan, 2012 U.S. Dist. LEXIS 25063 (N.D. Cal. February 10, 2012), the Court refused to require that the plaintiff appear for an independent medical examination (“IME”) because Metropolitan Life Insurance Company (“MetLife”) failed to request the IME within 45 days, as required by 29 C.F.R. § 2560.503-1.  With the ruling, the District Court confirmed that the time limits set forth in the Department of Labor regulation apply to claims that are remanded to an ERISA administrator following litigation. On May 13, 2011, the Court ruled that MetLife abused its discretion and improperly denied plaintiff’s claim for long-term disability (“LTD”) benefits made under an ERISA-governed employee welfare benefit plan.  With …

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Buying Disability Insurance: What You Should Be Looking For

Posted in: Disability Insurance, Disability Insurance News, Insurance Litigation Blog, Insurance Questions and Concepts December 14, 2011

What Are the Advantages of Buying Disability Insurance?  What Should You Be Looking for in a Disability Policy?  McKennon Law Group PC partner Robert J. McKennon has been litigating disability insurance claims for over twenty-five years and gives his advice on buying disability insurance.…

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