Articles Posted in Disability Policies

Attorneys who handle disability claims in the Dallas – Fort Worth area need to have an understanding as to how “disability” is defined.

The most commonly used definition used in Texas law is the Worker’s Compensation definition. In the 1944, Texas Supreme Court opinion styled, Texas Employers’ Insurance Association v. Mallard, the Court held that the standard definition of “total incapacity” is that “a person is disqualified from performing the usual tasks of a workman, in such a way as to enable him to procure and retain employment …” This definition has been broadened over the years. Total disability as that term is defined under the Workers’ Compensation Act and as that term was defined for the jury in the workers’ compensation case does not preclude the possibility of rehabilitation. The definition of “total incapacity” given to the jury in the workers’ compensation case stated that it “does not imply absolute inability to perform any kind of labor, but means that one is disabled from performing the usual task of the worker, not merely the usual task of any particular trade or occupation, to such an extent that he cannot get and keep employment requiring the performance of the usual task of a worker.” This has been stated in at least two cases. One was the 1963, Texas Supreme Court case, Texas Employers Insurance Association v. Hawkins. The other is a 1992, Texarkana Court of Appeals case styled, Southwestern Electric Power v. Martin.

The definition of “Total Disability” is a little different. Total disability is a relative matter and depends chiefly on the circumstances of each case and on the nature of the occupation and the capabilities of the person injured. It does not mean absolute physical disability of the insured to transact any kind of business pertaining to his occupation, but exists if he is unable to do any substantial portion of the work connected therewith. This is told to us in the 1961, Texas Supreme Court case styled, Prudential Insurance Company of America v. Tate.

Arlington lawyers need to have understanding of disability insurance policies to properly advise a prospective client.

Regarding the commencement of coverage, disability policies normally require that any claimed disability occur while the policy is in effect or within a specified time after the claimed accident or injury. Here is an example. A policy may provide coverage for an illness or injury that “totally and continuously disables the insured within 30 days of the date of the accident so as to prevent him or her from performing each and every duty pertaining to his or her occupation.”

Most disability insurance policies will distinguish between disabilities caused by illness and those resulting from accidental injury. The Beaumont Court of Appeals issued an opinion in 1978, in the case Lone Star Life Insurance Company v. Griffin, wherein a policy provided that the insurance company would pay the insured $1,000 per month for 60 months for an accidental injury resulting in total disability and that it would pay $1,000 per month for 24 months for total disability resulting from sickness.

Arlington insurance attorneys need to know the issues presented in policies of disability insurance.

Disability income policies typically specify an amount that will be paid in the event of a disability, as that disability is defined in the policy, and a maximum length of time for which such benefits will be paid. An example would be $1,000 a month for 180 months.

Something to be aware of is that the policy holder does not always have to prove that they actually lost the amount of earnings protected. Most the time, the benefits are payable even if the policy holder is unemployed at the time of the disability.

Fort Worth insurance attorneys who handle disability insurance claims need to know about this case. It is styled Occidental Life Insurance Co. v. Duncan. The opinion was issued by the San Antonio Court of Appeals in 1966.

Here is some relevant information.

Duncan was engaged in the selling of labels as an independent contractor on a commission basis. The company he represents manufactures labels and Duncan sells them, generally to canners. He has been in the label selling business for some twenty years. He was in an airplane accident on October 25, 1957, and was rather severely injured, Occidental paid him for total disability from the time of his accident until September, 1963, when it stopped payment. This suit by Duncan followed.

Insureds in Grand Prairie, Arlington, Weatherford, Fort Worth, Mansfield, Dallas, and other places in Texas, who have some form of disability insurance will too often, have to seek the assistance of an experienced Insurance Law Attorney when they make a claim. This is because insurance companies that issue disability policies are reluctant to pay these types of claims.

A case decided in 1978 serves as a good example. This is a Beaumont Court of Appeals case. The style of the case is, Lone Star Life Insurance Company v. Joseph B. Griffin. Here is some background.

Griffin testified that as he was returning to his home from his farm, he passed by his drugstore. As was his custom, he entered the store to see if everything was normal (having been burglarized several times in the past). He smelled smoke which he found to be coming from the rear of his building. He testified that he emptied his fire extinguisher but his efforts were futile; that he was trying to get out of the building when an aerosol can exploded in his face; that he lost consciousness while upon the floor of the store near a door, and regained consciousness later in a hospital.

Whether you live in Grand Prairie, Fort Worth, Dallas, Weatherford, Arlington, Mansfield, Irving, or anywhere else in the state of Texas, too many times when making a claim for insurance benefits, you are forced to hire an attorney. An experienced Insurance Law Attorney is valuable for recovering monies due under an insurance policy and a disability insurance policy in particular.

An example of the above in noted in a 1966 case that was decided by the Houston Court of Appeals. The style of the case is Continental Casualty Company v. Walter Earl Vaughn. Here are a lot of facts in this case.

The evidence showed that on April 10, 1962, Vaughn wrote Continental a letter stating he had sustained a back injury on March 30, 1962, and that he was in Leggett Memorial Hospital, and did not know how long he would be hospitalized or unable to work. Vaughn returned a standard claim form he had been sent, reporting that he had “a back injury in the nature of a ruptured disc that occurred on March 30, 1962 while loading a load of tubing on a truck in Houston.” The same report contained a statement by Vaughn’s doctor saying Vaughn had a ruptured intervertebral disc between Lumbar 4 and Lumbar 5; that the accident occurred on March 30, 1962; that Vaughn first consulted the doctor on April 1, 1962; and that Vaughn was to have a spinal fusion. Continental sent a one month’s indemnity and a thirty days’ hospital indemnity. The indemnity continued for another month after another claim form was filed.

A lot of people in Grand Prairie, Arlington, Mansfield, Irving, Fort Worth, Dallas, Hurst, Euless, Bedford, and other places in Texas will have a disability policy. What they need to understand is the conditions under which the policy pays benefits.

The Texas, 14th Court of Appeals, issued an opinion recently styled, “Chester Humphrey v. AIG Life Insurance Company, in which a disability policy was at issue. Here is some background.

Chester Humphrey, sought total disability benefits from his employer’s insurance company, AIG, following an on-the-job injury. Because AIG denied Humphrey’s claim, he sued.

Workers in Grand Prairie, Fort Worth, Arlington, Irving, Dallas, Mansfield, Cedar Hill, Duncanville, Mesquite, Garland, and other places in the metroplex area would have an interest in the following case.

This a United States Court of Appeals for the Fifth Circuit case styled, Habiba Ewing v. Metropolitan Life Insurance Company. The opinion was issued on June 7, 2011, after an appeal from the district court. The appeals court confirmed the finding in favor of Metropolitan.

Here is some information:

Anyone in Grand Prairie, Arlington, Irving, Mansfield, Dallas, Fort Worth, Cockrell Hill, Oak Cliff, De Soto, Duncanville, Lancaster, or any other place in Texas, who has disability insurance to help in a time of need, would be interested in the following case.

The case was decided by the The United States Court of Appeals for the Fifth Circuit. It is an appeal from a summary judgment in the district court in favor of the insurance company. The case is styled, Gwendolyn Byrd v. Unum Life Insurance Company of America. The opinion was issued on April 7, 2011.

The plaintiff, Gwendolyn Byrd, filed suit challenging Unim Life Insurance Company’s decision to terminate her long term disability benefits. The job of this appeals court was to review the case for an abuse of discretion by the district court. Here is some background.