My disability claim has been denied, but why am I losing my health insurance?

The old saying “when it rains, it pours” frequently comes to mind when dealing with a denial of disability benefits.  When an individual’s disability claim has been denied by the insurance company, this usually results in a trickledown effect resulting in the loss of other benefits the person was previously receiving.  These lost benefits may include health insurance, dental and vision insurance, a previous life waiver of premium benefit, years of service credit for retirement plans, loss of monthly car or loan forgiveness payments, and other benefits.  One of the most popular benefits that is typically affected is an individual’s health insurance.

Frequently, when an individual is unable to work because of a disabling condition, the individual’s employer will continue to retain him or her for a period of time as an employee.  This period of time may be anywhere from a couple of weeks to several years.  Sometimes the individual may be designated by the employer as an “inactive employee” and indefinitely continue to receive employment-related benefits, such as health insurance coverage.  However, once the insurance company denies or terminates the disability claim, which in effect generates a false signal to the employer that the person is no longer disabled; the employer will commonly require the individual to return to work or face being terminated.  Unfortunately, most people are unable to return to work in this scenario, and are terminated by the employer, resulting in the loss of health insurance coverage.  If the individual is not entitled to COBRA, or cannot afford COBRA premiums, this situation creates a huge financial burden on the individual, as they no longer have valid health coverage.  This is compounded even more when the person is ineligible for Medicare or Medicaid.

Individuals should be aware of the direct and indirect financial ramifications that a denial of disability benefits may have on them, underscoring the need to seek competent legal help upon a denial of disability benefits.

Does "Disabled" mean "Totally Incapacitated"?

Many insurance companies attempt to redefine the term “disability,” employing a very subjective and harsh standard contrary to the terms of the policy. Such tactics breed the false notion that a claimant must be an invalid to be eligible for disability benefits. This creates a quandary for claimants who genuinely cannot work due their condition but feel helpless and even guilty about applying for disability. This is often the case with clients who have chronic pain. Some days their pain may be less severe than it is other days. However, continuing to adhere to regimented work schedules and demands tend to exacerbate their pain, often relegating claimants to bed rest for several days at a time to recuperate.

So what renders a claimant disabled?  The answer is simple. The inability to perform the material and substantial duties of one’s job on a consistent basis renders one disabled.  The courts have addressed the failure of insurance companies to account for a claimant’s ability to continue performing his/her job consistently on a full-time basis. Claimants with chronic illnesses will often have to miss a minimum of 2 to 3 days a month from work due to flare-ups with their condition. The accumulation of these missed days from work obviously exceeds the amount of sick leave allowed by most employers.  Therefore, whether a claimant is capable of getting out of bed every day and managing their basic needs is not the threshold requirement for determining disability status. Many claimants can continue caring for their basic needs, but only with significant accommodations and a very flexible schedule with no time demands. As we all know, the ability to complete tasks in a timely manner is vital to job performance.