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Frequently Asked Questions
Please choose from the following frequently asked questions to learn more...- How does Disability Insurance Work?
- I can no longer work and my insurance company is refusing to pay me. What can I do?
- I am out of work, how can I pay my lawyer?
- What types of Cases do you handle?
- Why do Insurance companies refuse to pay?
- What is ERISA?
- Am covered by a private plan or ERISA?
- When I apply for insurance, what kind of information is collected?
- What are independent sources?
- Do I have the right to know if the company has prepared an investigate consumer report about me?
- What can I do if I disagree with the information contained in an investigative consumer report?
- Who has access to information about me?
- Can an insurance company cancel my policy?
- Can a company increase my premium after the policy has been issued?
- Do I have to pay any penalty if I cancel my insurance in the middle of the term?
- What should I do if I have a complaint?
Q: How does Disability Insurance Work?
A: Individual Disability Insurance (DI) is designed to protect employed individuals from financial disaster in the event of a disability that prevents a person from working. The odds of an individual becoming disabled for ninety days or more before age 65 is one in eight. In contrast, the odds of a house burning down are nearly one in 1,200. As medicine advances, doctors can more often prevent death; however, frequently the patient suffers from a permanent or long-term disability. In addition, a study of 2000 severely ill patients indicates that although 96 percent had health insurance, 31 percent lost their life savings. Twenty-nine percent of the patients lost their major source of income as a result of their illness. In the United States, 48 percent of all mortgage foreclosures are caused by the onset of a disability. Unlike workers compensation, DI supplements an individual's income even in cases where their sickness or injury did not result from a job related incident. For this reason, the availability of DI, and the ability to collect on a DI policy in the case of a long-term disability are extremely important for the average worker. ^ top
Q: I can no longer work and my insurance company is refusing to pay me. What can I do?
A: Unfortunately, you may need legal help. A lawyer can help you protect your policyholder rights and put an end to delaying tactics. If the insurer denies coverage, you can attempt to get the court to order short-term payment. Usually however, it will take over a year to fight for your benefits while the case is in litigation. The amount you may receive may include damages for the insurance companies bad faith in denying your claim. ^ top
Q: I am out of work, how can I pay my lawyer?
A: If you have a private disability policy, have been disabled and the insurer is refusing to pay, our attorneys may represent you on a contingency basis, where the you would pay out of the proceeds of any eventual settlement, with the lawyer receiving a percentage of the recovery from the insurance company. ^ top
Q: What types of Cases do you handle?
A: We handle claims by individuals for non-payment and termination of payment long-term disability (LTD) benefits. We also represent people in denials of benefits under long-term disability plans, non-ERISA (private and public employee group plans). We do not handle ERISA claims. ^ top
Q: Why do Insurance companies refuse to pay?
A: Economics. In the past twenty years many high-income professionals were believed to be good risks for disability income insurance. The industry believed most or many would never makes claims, but unfortunately, the number of people injured defied the odds. The number of claims mounted and the insurance companies such as Unum Provident Group, Paul Revere and Guardian faced losses on these policies. The industry aggressively looked for ways out of paying these policies, and in some cases crossed the line, unlawfully denying many professionals owed money under insurance contracts. ^ top
Q: What is ERISA?
A: ERISA is an acronym for the Employee Retirement Income Security Act of 1974. ERISA was passed by Congress in 1974 to combat corruption in many pension plans. Ironically, ERISA was not originally designed to control medical or disability insurance plans, but the phrase in the act "employee welfare benefit plan," has been subsequently interpreted by federal courts' to ERISA control over nearly all private employee benefits, including health, disability, life and pension plans. We do not handle ERISA claims. ^ top
Q: Am covered by a private plan or ERISA?
A: ERISA controls nearly every employer-sponsored benefit plan, but does not apply to individual policies purchased privately. If you are a public employee you are also outside of ERISA. ^ top
Q: When I apply for insurance, what kind of information is collected?
A:Your insurance company or agent will require that you disclose certain personal information to determine your eligibility for insurance coverage and establish the price of coverage. In addition, companies may also obtain information from independent sources. ^ top
Q: What are independent sources?
A: Independent sources may include your prior insurance company and/or consumer reporting agencies or inspection services. These organizations may contact you, your family members, neighbors, or employer. ^ top
Q: Do I have the right to know if the company has prepared an investigate consumer report about me?
A: The insurance company must inform you if a consumer information report is ordered. You also have the right to receive a copy of the completed report. You may write to the company providing them with proper identification (your name, address, and policy number) and state what information you must provide this information within 30 days. The company will also identify to whom the information has been disclosed during the preceding two years. ^ top
Q: What can I do if I disagree with the information contained in an investigative consumer report?
A: You may request, in writing, a correction, an amendment or a deletion of any recorded information about you in the company's possession. The company will review the file and make the necessary corrections. However, if the company disagrees with you, they must inform you of the reason. If you are not satisfied with their explanation, you have a right to file a statement setting forth what you think is correct and why you disagree with the company s information. Your supplementary statement(s) will be placed with your file, and anyone reviewing the disputed information will be made aware of the statement(s). ^ top
Q: Who has access to information about me?
A: The information collected is kept by the company. It can be used in connection with issuing, servicing and continuing insurance policies, and processing claims. With your prior authorization certain persons or organizations may obtain your information, they are:
- Persons performing a business function for the company, e.g. auditors.
- Your agent or broker.
- Insurance investigators and support organizations,
other insurance companies with respect to an insurance transaction involving you. - Independent claims adjusters.
- Actuarial or research organizations conducting statistical or research studies; however, they must agree not to identify any individual in the report.
- Other companies with which your company is affiliated.
- Finally, it may be given to persons or organizations for marketing purposes. However, you may indicate in writing if you do not want the information to be disclosed for such purposes. You may do this when you apply for coverages.
Q: Can an insurance company cancel my policy?
A:. Generally, a company is required to offer to renew your policy contingent upon premium payment. However, if the company is not renewing your policy, it must mail or deliver a notice of non-renewal to you at your last known address, at least 20 days before the end of the policy period (see glossary of terms) date. The non-renewal notice will state that, upon your written request, the company will give you the reason for non-renewal. You must make your request not later than one month following the expiration of the policy period. Effective July 1, 1987, in the event that the company fails to send you a notice of non-renewal at the appropriate time, your policy will remain in effect for 20 days from the date that the proper notice is sent. If you have already replaced your policy with another company, your policy will terminate on the effective date of your replacement policy. If you felt the company's explanation is unfairly discriminatory and/or in violation of other provisions of the California Insurance Code (CIC), you can have the matter reviewed by the California Department of Insurance, Underwriting Services Bureau (USB). ^ top
Q: Can a company increase my premium after the policy has been issued?
A: A company has 60 days from the policy's effective date in which to verify the rating and underwriting of a new policy. Within these 60 days, a company must notify you of any error and subsequently uprate. After 60 days, the company must stand by the original quote. If within the first 60 days you do not accept the increase in premium, you may ask the company to cancel the policy. If the company or its agent has caused the error, the earned premium must be calculated on a pro-rata basis on the original quote. If the rate increase resulted from incomplete or erroneous information on the part of the applicant, the company can calculate the earned premium pro-rata on the corrected premium. However, if you have agreed to pay a fully earned policy fee which is shown on your application and policy, the company will not return the fee to you. ^ top
Q: Do I have to pay any penalty if I cancel my insurance in the middle of the term?
A: Generally, if the policyholder prematurely initiates a cancellation, the premium would be calculated on a short-rate basis whereby part of the unearned premium is being retained by the company to cover administrative expenses. However, some companies may calculate the premium on a pro-rata basis. Read your policy contract to find out the cancellation provisions of the company. ^ top
Q: What should I do if I have a complaint?
A: If you have a complaint against a company or have specific questions ^ top
Other Attorneys not certified by the Texas Board of Legal Specialization
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