Assurity doesn’t operate quite like other long term disability carriers, and it offers some unique products—most notably, individual long term disability policies that provide up to two years of disability benefits at an affordable price. Unlike employer-provided group disability policies, Assurity’s individual policies allow claimants to take advantage of a state-law interpretation of their insurance contract instead of litigating the issue under the far stricter federal standard. Learn more about Assurity disability benefits and what claimants will need to show to recover benefits under their long term disability policy.
GREGORY DELL: Hi I’m attorney Gregory Dell, and I’m here with attorney Stephen Jessup. And we’re going to talk about disability insurance claims with Assurity Insurance company. Now, Steve, this is one of the smaller disability insurance companies that we deal with. Not that they’re a small company, and they have a long history, because they’ve been around for over 100 years, but they offer some unique, very specialized type insurance products. But they offer a decent volume of them. Enough that people contact us about them, and we’ve been able to help people around the country.
So let’s start, first of all, what’s unique about the Assurity Insurance products.
STEPHEN JESSUP: I think one of the most unique things that you’re going to find with them is on the long-term aspect on an individual disability. It usually covers two-year periods. And with that, one of the big things that they can offer is affordable premiums. As opposed to some of the larger companies, where the annual premiums are extremely high, Assurity makes a kind of cost-effective product so people can secure the benefits. So they really target a market that most insurance companies don’t. I think that makes him really unique.
GREGORY DELL: Yeah. And so this trend towards– or for them, this is a unique product. And every insurance company can come up with their own product. It obviously has to be approved by the Department of Insurance in multiple different states in order for them to sell it, but when you offer a two-year disability policy, and it’s one that they can buy on their own, I find that more of what I would say is like a supersized short-term disability policy.
STEPHEN JESSUP: A short long-term.
GREGORY DELL: Yeah. But the advantage of this policy is that it’s individual. And why is that an advantage that it’s an individual disability policy, versus a group employer-provided policy?
STEPHEN JESSUP: The biggest benefit you’re going to have is any potential legal recourse down the road. So as opposed to an employer-provided policy that’s governed by a federal statute, ERISA, and that comes with a whole slew of laws that seem completely archaic and unfair– and as an individual policy, in the event that their claims denied, you get to file suit in state court under a breach of contract. You can testify. Your doctors testify.
So there’s a lot more fairness to it. And with that type of policy, we’ve seen, from our experience, insurance companies tend to act differently, because there could be larger financial repercussions if they aren’t doing what they’re supposed to be doing. So that’s a great benefit to you. And then to, again, be able to get that at really an affordable rate compared to most of the other insurance companies, it’s a good way to protect income. And like you said, it’s not super long-term, but two years, it’s this idea if something catastrophic happens, and you can’t work, it’ll at least cover you for a period time till you get back to work.
GREGORY DELL: And so one of the things we talked about, which is complicated legal issues about the standard of review, that we would think these are individual ERISA exempt policies. However, I just want to throw a cautionary red flag out there, that if an employer puts together a voluntary plan and says to all the employees, hey, if you want the long-term, get it. If you don’t, we don’t care. But we’ve got a group rate and it’s organized. There is an argument potentially to be made that that claim, even though you have your own individual policy, is governed by ERISA. It’s certainly an issue that we’ll discuss and look into when we’re reviewing your claim, but it doesn’t even come into play unless the claim is denied.
STEPHEN JESSUP: And also, they do write some short-term policies for businesses for companies. So then you get into that gray area too of ERISA– the funding, all the types of stuff that come with that. If you buy it though, on your own through an agent, you can usually avoid those pitfalls.
GREGORY DELL: So one of the big advantages, though, of the fact that it’s only a two-year policy is the fact that Assurity is likely not really going to want to aggressively litigate these claims. Because whether a claimant’s seeking one year or 15 years of benefits, the litigation work is the same. Nothing changes because of the duration of the period. But the fact that it’s such a short period of time, they’re going to highly scrutinize the claim.
So I want to just discuss for a few minutes about, what does a claimant need to do to be prepared to get approved benefits by Assurity?
STEPHEN JESSUP: It’s always going to go back to documentation. What is the medical condition? Are you treating– because sometimes people think, oh, I have this, I can just file, and they’re going to pay me a benefit. But you have to have medical records that support why you can’t do your job. Your doctors are going to need to be on board, because they’re going to have to fill out forms too.
So you really have to put in work on the front end. It’s not as simple as, say, for instance, you hurt your back, and you think, well, my back hurts, I’m going to file for disability. Well, you better have gotten treatment, things like that. So first and foremost, it’s the medical documentation. Because every insurance company, that’s where they’re going to start with first– are those medical records really supporting that you cannot do your job.
So you want to make sure that the doctor’s documenting your complaints properly. And if you’re your condition requires a specialist, it’s also really advisable to get into a specialist as soon as you can. And depending– I mean, it could be months sometimes to get an appointment, so you really have to be proactive in your medical treatment.
GREGORY DELL: Right. I wanted to stress that because it’s such a short period of time, it’s really, really important to do it right from the beginning. And a lot of claimants call us to assist with the application process, which is a service that we offer nationwide. But the point is that you may be dealing with, and likely are have been dealing with, a discomfort due to a medical condition that’s been bothering you for months to maybe years, and we work with claimants months, weeks, years before they even file to make sure everything’s documented. Because, at the end of the day, your claim is only as good as it is on paper. And explain why that is– why is it only as good as it is on paper once the claim gets submitted?
STEPHEN JESSUP: Because that’s the story, if you will. That’s the history that’s going to be known. They’re going to take a look back and see, were you discussing with your doctor the problems that you were having initially? Was the doctor noting that was causing issues at work? So that’s the real paper trail.
You can talk to an insurance company, tell them what you’re going through, what your job entails– all these different types of things– and they’ll listen. They’re going to take that into consideration. But it’s the hard evidence that’s on paper that’s going to be the most important. No matter what type of insurance, paper trails are the most important things. So you have to have that documentation, because they’re always going to rely on that more than anything.
When they have their doctors review your medical information, they’re looking at your records. They’re not going to talk to you, they’re going to look at your records.
GREGORY DELL: So in terms of the experience of dealing with Assurity overall, if somebody has their claim denied, what kind of time frame should they expect if a lawsuit has to be filed? And this is a real tricky situation, because you’re going to talk about time frames in a second, but keep in mind, we’re dealing with a two-year disability period.
STEPHEN JESSUP: It’s really tricky, in the sense– for instance, I recently filed a lawsuit against an insurance company, and the anticipated trial date the judge gave is a year and a half out. So if your claim’s denied and you’re going through a an appeal process to try to get them to overturn their decision, realistically you can maybe expect that could take anywhere from six to nine months. And if it’s still denied and you file a lawsuit, your case may not be heard, may not be decided, especially since you’re not going to be governed by ERISA– the courts will extend cases, continue them– you might be three years out before you’re actually in court discussing anything. And on this two-year policy, you could be back to work. You don’t have any of the benefit of that money.
So you really want to make sure it’s done right upfront to avoid these problems. Because, ultimately, this policy is going to require you go back to work. It’s limited in its nature. So you don’t want to have– you buy this policy, and you think, this will cover me while I’m out. You don’t want to find yourself in a situation where three years down the road you stop being paid on a policy that was only going to pay for two.
GREGORY DELL: Right. So for the people who call us with Assurity, we have either two scenarios. One is, let’s file right away, because this is a short period of time, and we want to try to get benefits quick. But the other alternative is to look at the claim and say, is there something here that we can do, where we can build additional medical information for the claimant and get them to the point where possibly we could get Assurity to change their mind?
Also, having a lawyer involved sometimes bring some firepower, especially in these limited two-year benefit periods. Because they’re going to say, well, now it’s more the lawyer got involved, you got additional medical support. I like the position. It’s a stronger position now. Do we really want to litigate?
Our costs are going to be– these cases are $100,000 all day long to litigate. Most of the Assurity policies barely have a value of $100,000. So now, the insurance company, you really have leverage as a claimant when you have a law firm that knows what they’re doing, backing you here, where, at the end of the day, it’s probably going to push towards a settlement, where it doesn’t make sense to litigate any further. And you’re getting money for the claimant a lot quicker than they would waiting a full two years out.
STEPHEN JESSUP: And end even prior to the lawsuit and all that stuff, getting a lawyer involved, like you said, they realize, all right, this could cost us money. An insurance company is a business. They’re about their profits, margins, all that– their bottom line. And they’re going to evaluate. If your monthly benefit isn’t that large, they might even start thinking, well, they’ve already gotten an attorney involved. It’s going to weigh in their mind– is it going to cost more for us to fight it than to pay the benefit?
GREGORY DELL: And then, the other important thing here is that if we take on a case with Assurity, and it’s a litigation case, we don’t charge any fees or costs unless we win the claim anyhow. So there’s really no risk for the claimant at all. So, in summary, no matter what stage you’re at with a claim with Assurity, feel free to give Stephen or myself a call. We represent claimants all over the country. And when you call us, we’ll provide you with an immediate free consultation.
We appreciate you considering our law firm, and we look forward to the opportunity to speak with you.
Because Assurity’s policies often only provide disability benefits for two years, claimants need to get the ball rolling quickly before time runs out. By having an attorney on your side, like a member of the experienced legal team at Dell & Schaefer, you’ll be able to leverage this timing issue in your favor by nudging Assurity toward a settlement well before this two-year period is up. Regardless of where you are in the disability claim process, give us a call or visit our website today to set up your FREE consultation with one of Dell & Schaefer’s long term disability attorneys.