Medical Basis for Disability Claims Under California Law
Definition of “Disabling Conditions” for Insurance Claims Purposes
Clients have frequently asked us for more information on disability policies and the conditions that could qualify a consumer for coverage under a disability policy. When insurance carriers decide to provide disability insurance policies to California consumers, the insurers must follow California law and regulations. California law will determine the definitions of “disability” and other key words in that policy.
In California, to be considered disabled, you must be unable to perform the material and substantial duties of your job with reasonable continuity, in the usual and customary way. This definition comes into play with the limitations and restrictions that your doctor has placed on you.
Typical Disabling Conditions
Clients frequently ask us if we have ever handled a case involving their specific disability. If you have a disability that is affecting your occupation or daily life, contact us and we can advise you on the potential merits of your disability claim. The following medical conditions including only some of the disabilities that our clients have had when filing a disability claim:
- Back and neck injuries
- Neurological injury
- Cardiac (heart) conditions
- Multiple sclerosis
- Eye injuries or blindness
- Chronic fatigue syndrome
- Carpal tunnel
- Lyme disease
- Rheumatoid arthritis
- HIV / AIDS
- Kidney problems
“Change in Definition” in Disability Claims
In some cases, our clients have contacted us after receiving benefits for a period of time, usually 24 or 36 months. Their disability insurance carrier has informed them that they are no longer eligible to receive benefits because of a “change in definition.” Essentially, after a period of time, the insurer will refer to the policy that requires that you must be disabled from any occupation, not just your previous occupation, to continue to be eligible to receive disability benefits.
We work with clients faced with a “change in definition” or other exclusions to fight against the insurer’s interpretations of the policy limitations.
Los Angeles Disability Claims Attorneys
At the Los Angeles area law firm of Donahue & Horrow LLP, you will find an attorney with substantial experience in disability insurance matters. We can help you with any California disability claim or insurance appeal.
Contact Donahue & Horrow LLP, for questions about disabling conditions, a “change in definition,” advice on making a claim, or help in dealing with insurance bad faith practices or claim denial.
There is no obligation, you do not need to come to us, and your consultation with an experienced lawyer will be free of charge.