California Disability Insurance Claim: How the System Should Work

Free Insurance Quote Comparison

 Secured with SHA-256 Encryption

Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

Full Bio →

Written by

UPDATED: Aug 5, 2019

Advertiser Disclosure

It’s all about you. We want to help you make the right legal decisions.

We strive to help you make confident insurance and legal decisions. Finding trusted and reliable insurance quotes and legal advice should be easy. This doesn’t influence our content. Our opinions are our own.

Editorial Guidelines: We are a free online resource for anyone interested in learning more about legal topics and insurance. Our goal is to be an objective, third-party resource for everything legal and insurance related. We update our site regularly, and all content is reviewed by experts.

Disability insurance pays an insured person an income when that person is unable to work because of an accident or illness. While that seems simple enough, the truth of the matter is that many disability insurance carriers don’t follow the rules when it comes to providing the benefits they promised.

The rules of disability insurance

Bob Scott, a California disability insurance attorney and partner with the Advocate Law Group, sat down with us recently to discuss how the system should work. Right off the bat, Scott told us that it’s the definition of a disability that is often the greatest unknown, but many states have now imposed their own definitions. He explained:

Each state can impose a more rigorously definition of disability in individual disability policies for their own citizens as to policies issued by any disability carrier. It doesn’t matter where they’re from; if they sell policies in California, then they have to comply with California law – which is based on insurance regulations and California appellate court decisions that have interpreted the standard of disability.

California Individual disability policies

Scott told us what happens with individual disability policies in California:

In California, it must be shown that you cannot do the material and substantial duty of your position with reasonable continuity. What that means is that we have to look at just your job, not anybody else’s job. That, of course, is the only thing you’re insuring anyway because you don’t know what anybody else does, you just know what you do – and that’s the disability policy you’re buying.

So it looks at the material duties of that job, and while most of those focus on physical activities, they could also include or mostly focus on more mental capabilities as well depending on what type of occupation you have. Then we look at your job and compare that to the restrictions and limitations that your doctor has put on you.

Insurance carrier ploys

One of the ploys disability carriers do is to use a nurse to reapply the restrictions and limitations without talking to your employer as to what your job was, and most importantly, without talking to your doctor, according to Scott. He explained:

They think they can get a nurse or a doctor who has no idea of the rules, in our case the California rules of disability, and have them say, ‘Well, the restrictions your doctor put you on are not reasonable.’ There is no language or policy allowance for them to do that. So, first we have to be careful of who’s determining what restrictions and limitations are to be applied to the formula. Second, we’ve got to go through what your job duties really are – and those will come from your doctor. Third, you need to determine whether you can do it with reasonable continuity – day after day, five days and 40 hours per week.

Scott says that if you can’t meet all of those criteria, then that becomes the definition of disability to be applied for your occupation in California.

If your disability insurance company has denied your valid benefits, contact an attorney whose practice focuses in disability law to discuss your situation. To speak with a qualified disability insurance attorney, please click here. Consultations are free, without obligation and are strictly confidential.

Free Insurance Quote Comparison

Enter your ZIP code below to compare cheap insurance rates.

 Secured with SHA-256 Encryption