Reliance Standard Loses in Appeals Court for Wrongly Denying Benefits to an Injured Ship Captain
Reliance Standard lost in the appeals court for wrongly denying benefits to an injured ship captain. Captain Miller suffered from a number of medical conditions requiring him to take medical leave, including injuries from a fall.
While on leave, Reliance Standard took over the disability insurance coverage for his employer. As a result, when Captain Miller applied for long term disability insurance benefits, Reliance claimed his condition was pre-existing because he filed within the first year of coverage.
The Reliance Standard policy contained language that allowed an employee to be covered if they could prove they were eligible. The problem, however, the policy was not clear on what an “eligible person” meant.
Captain Miller argued that he was an eligible person because even though he was not actually working, he was still an employee of the company when he became disabled. He also argued that he was a full-time employee, just not working due to his leave. The court agreed and awarded disability benefits.
It is important to understand the policy provisions and how to properly argue them. In this case, the policy definitions were ambiguous, meaning they were not clear in the meanings. In this situation, under the law, the court must interpret an unclear policy provision in favor of the claimant.
If you have filed for disability insurance benefits and your insurer is denying your claim based on policy language, contact our experienced disability insurance attorneys today. We know how to fight against an insurance company's wrongful application of a policy provision.
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