Another state has joined the ranks in support of the injured and disabled. A doctor in a northern state had filed a long-term disability benefits claim stating that he was not able to work because of severe pain in his back. The insurance company denied his claim, so he appealed his case in federal court. His appeal was denied based on a discretionary clause in the insurance company’s policy that required judges to review cases not on the merits of the claim, but on whether that denial met that insurance carrier’s own standards. In Wisconsin and other states across the country, discretionary clauses like this one are still allowed, although it appears that this is changing rapidly.
As a part of pursuing his disability claim, this doctor and his advisors helped bring about a change that will affect many. The campaign that they initiated succeeded recently when the governor of that state signed a bill prohibiting the use discretionary clauses in determining long-term disability benefits. This doctor’s 2-year struggle to receive his benefits ended in a victory and can be inspirational for those who are currently facing the same struggle with their own long-term disability case.
Many factors are considered when a long-term disability claim is filed. Medical reports, test results, and statements from medical professionals must all be submitted correctly. Specific forms are required and often there are deadlines by which these items must be submitted. Becoming familiar with the rules and regulations that apply to submitting a claim can help ensure that has met all the requirements for consideration. Even that, however, may not be enough.
Wisconsin has not yet prohibited the use of discretionary clauses in determining long-term disability benefits. It is important for those that are injured and unable to work to know what rights they have under current state laws, and if the insurance provider has included such clauses in their policy. With the recent trend of states that are disallowing the use of clauses such as this to deny benefits, every case is a new opportunity to bring about a much needed change where it is needed.
Source: turnto10.com, “I-Team: New law bans discretionary clauses,” Jim Taricani, June 25, 2013