If I Work for Myself and Get Injured, What Happens?

Disability Claims Under Individual Disability Policies:

Getting the Peace of Mind You’ve Paid For

From my own experience as a business owner and as a lawyer focusing on litigating long-term disability (LTD) litigation, when it comes to Long-Term Disability insurance, I’m of two minds. I see when claims are denied and often wonder if it’s worth the cost of coverage, assuming any future LTD claim of mine could also very easily be denied.

On the flip side, I also understand and appreciate the value of disability coverage when claims are paid. I would venture that most professionals and business owners tend to air on the side of caution and risk avoidance, purchasing various types of disability insurance in the event they are not able to work.

For those of us who take the leap, we often “buy it and forget it”. We expect that if we become disabled in the future, our LTD benefits will be paid to us and the premiums we have been paying for many years will have been well worth the cost.

Although, we may not think about our LTD insurance often, knowing we have it gives us the “peace of mind” that should disability strike, our families, our businesses and our incomes will be protected. Unfortunately, that is not always the case.

Business Owners are at risk of hard-to-prove “Invisible Disabilities”

As highly motivated, hard working professionals and entrepreneurs with cognitively demanding work, we tend to focus our time and energy on our professional practices and businesses and on our families and not on the possibility of an illness or injury that could potentially cause us to be unable to do our work and run our businesses.

That focus is in large part, the reason why we have been successful but it may also be why we are at risk of serious disability, particularly with respect to invisible disabilities (such as depression, anxiety, burnout, panic, PTSD, chronic pain, immunological conditions, neurological conditions, and other difficult-to-prove disabilities). Unfortunately, disability claims for these types of conditions are often denied at the outset or terminated prematurely.

The denial or termination of an individual/private disability claim (or business interruption or creditor disability claims) can have serious and far-reaching consequences. If your claim is denied, “time” is very much “money”, in these cases and the sooner steps are taken to resolve your matter, whether it be by way of appeal or litigation, the better you, your family, and your business will fare.

In this article we will discuss when to submit an individual LTD claim; why these claims are denied; and what to do if your LTD claim has been denied.

When to make an LTD claim under an Individual Insurance Policy

Obviously, if you are not able to work due to an injury or illness, it is critical to submit your LTD claim right away to avoid any deadlines in your policy. However, with individual policies, you may even be able to apply for benefits before you become “totally disabled”. If you are still able to work at some capacity but you are only performing some of your duties, or if there has been a reduction in your/your business income as a result of your disability, it might be time to submit your disability claim. The timing of your claim can be critical to its success and to your future financial stability.

If you have a progressive or degenerative medical condition, you will want to consider submitting a claim before you are completely unable to work. An early claim may allow you the financial flexibility to reduce your workload and focus on managing your condition and doing other things that you enjoy, while you can. You may need to determine when your symptoms and limitations would meet the different tests for disability under your policy and when best to submit your disability claim.

Submitting a claim too early or waiting too long can have serious consequences for your finances and for your ongoing coverage under your policy. For example, if you continue to work when you are not at your best and as a result you make errors or omissions, potential professional liability claims could be made against you. When you stop working might also be a consideration if you are planning on selling your business.

Why are individual LTD claims denied?

There are many reasons why individual disability claims are denied or terminated. The insurance company may determine that you do not meet the various definitions of disability under your policy or that you have not provided “sufficient evidence or support” to prove your claim.

In individual disability policies, there may be multiple definitions of disability used by the insurance company to assess and deny an individual’s disability claim, including “Totally Disability”, “Residual Disability” and “Partial Disability”. Sometimes when a claim for “Total Disability” is denied or terminated, the insurance company has not assessed the claim under the other definitions of disability in the policy and our clients may be unaware of other potential benefits owing to them.

Your claim may also be denied if the insurance company determines that you did not suffer a loss of income (or your business did not suffer a loss); that you are not receiving appropriate treatment; or they may determine you can work at your business, not fully understanding the functional requirements of your work/business and how your condition prevents your from performing your duties. Often insurance companies underestimate or never bother to assess what the cognitive functional requirements are of professional occupations or business owners and this may result in the denial of your claim.

Individual disability claims can also be denied on the basis of misrepresentation. Misrepresentation is when the insurance company determines that you failed to disclose your medical or financial information at the time you applied for the coverage and had full disclosure been made, the insurance would not have been offered to insure you. In assessing your claim, they will request and review records to determine if you made full and accurate disclosure of your information at the time you applied for the insurance coverage would they have insured you, and if not, your claim could be denied on the basis of non-disclosure and misrepresentation.

​What to do if your individual LTD or business interruption claim is denied

It is important to take action as soon as possible if your disability claim is denied or terminated. By taking steps quickly, you will be better able to resolve your benefit dispute and protect yourself and your business.

If your LTD claim (or business interruption claim) is denied or terminated, you will typically have the option to appeal or litigate. Not all disability cases are the same. In some cases, appealing the denial will be the better option, while in others, it will be best to move swiftly and confidently toward litigating the denial of the claim with the representation of an experienced LTD lawyer. A disability lawyer will be able to assess your claim and strategize an approach that meets your individual needs as a business owner.

The services we provide individual policyholders, while similar to those we offer our other clients, are specifically tailored to our clients’ unique individual loss of income (LTD) policies and unique business-loss issues.

We treat our Individual Policyholder clients like we would want to be treated

Mulqueen Disability Law represents professionals and business owners whose disability claims have been denied or terminated by insurance companies. We have decades of experience appealing and litigating coverage and benefit disputes under individual disability and business interruption policies. We know how to correctly interpret and apply the provisions in our clients’ policies in a strategic and persuasive way to leverage successful outcomes for our clients.

Discuss your LTD Claim With Us Today

If you would like to discuss your Long-Term Disability claim Mulqueen Disability Law is an experienced law firm dedicated exclusively to the practice of LTD litigation. Providing Trauma Informed legal representation, we have represented thousands of disabled clients in their LTD cases. Contact us to schedule a free confidential consultation.

The preceding is not intended to be legal advice. This blog is made available for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog, you understand that there is no solicitor client relationship between you and the blog publisher. The blog should not be used as a substitute for competent legal advice from a licensed lawyer in your jurisdiction. If your disability claim has been denied and you require legal advice, contact a lawyer specializing in disability law.