In 1998, a New York appellate court held an insured was entitled to disability benefits even though she was not working at the time of her disability. This was because the policy did not require her to be actively employed when she became disabled.
Administrative Assistant Files for Disability
Before filing for disability, Ms. Burriesci left her job as an administrative assistant for a small company in Syracuse, New York. She was unsuccessful finding a new job and obtained unemployment benefits. While unemployed she injured her back. It caused her chronic pain.
Her physician determined that she was totally disabled. She applied for disability benefits and although first denied, the insurance company paid her three months of benefits. After, it denied any future disability benefits. Ms. Burriesci filed a lawsuit.
Insurance Company Moves to Dismiss Suit.
The insurance company moved to dismiss Ms. Burriesci’s lawsuit because she was unemployed at the time of her disability. That court granted the insurance company’s dismissal.
Policy Language Should Be Reasonably Interpreted
The appellate court disagreed with the dismissal and found that the insurance company unreasonably interpreted its policy. Because it did not include language that stated the insured must be actively working at the time that the disability arises, the policy did not exclude coverage for all unemployed insureds. The appellate court held that because Ms. Burriesci was attempting to return to an administrative assistant position, she was regularly engaged in her occupation and entitled to disability benefits.
Insurance Companies Cannot Pick and Choose How to Interpret Policies
Insurance companies will try to rewrite policy language or interpret it differently than it was intended for financial gain. In doing so, an insurance company violates its duty to the insured. The policy and its terms dictate whether an insured can receive benefits. An insurance company is not allowed to change it or unreasonably interpret it for its own benefit.
What Ms. Burriesci was forced to deal with is not uncommon. For example, in 2004 a Florida CEO was denied benefits while unemployed based an almost identical policy. That appellate court also held that the disability occurred while the insured engaged in their regular occupation even though at the time they were unemployed.
We have handled several cases where insurance companies have wrongfully denied benefits based on incorrect interpretations of policies. The experienced attorneys at Dabdoub Law Firm are prepared to fight for your benefits and know how to pursue them under the terms of your policy.
Disability Insurance Companies Have Lawyers. Shouldn’t You?
Because this law firm was founded to focus on disability insurance, we have developed a proven track record of success in this difficult area of law. We have:
- Expertise in disability claims
- Fought all major disability insurance companies and know their tactics;
- A track record of success;
- Won major disability lawsuits that created good law; and
- Recovered millions of dollars in disability benefits.
Because federal law applies to most disability insurance claims, we do not have to be located in your state to help. We help clients nationwide.
Call to get experienced disability lawyers on your side when:
- Submitting a disability insurance claim;
- Appealing a long-term disability denial;
- Negotiating a lump-sum settlement; or
- Filing a lawsuit against your disability insurance company.