Understanding the terms “activities of daily living” can be the difference between obtaining coverage or not for individuals applying for or seeking payments under a long-term disability insurance policy. To obtain compensation under many long-term disability insurance policies an individual must show they are unable to perform certain everyday tasks categorized as the “activities of daily living”.
The Centers for Medicare & Medicaid Services (CMS) lists the following six activities of daily living:
Most insurance carriers will find individuals who need assistance to do one or more of these activities of daily life as limited in their ability to work. This determines whether an individual will qualify for coverage under the policy. When an individual insured under a long-term disability policy becomes unable to perform an activity of daily living, they may start to receive insurance payments to cover the cost of the needed assistance.
Individuals who show an inability to engage in the activities of daily living may find it difficult to obtain long-term disability insurance in the first place. Most insurance companies require applicants to complete an inventory of their level of functioning with respect to these tasks. When an applicant indicates difficulty with one or more of the daily living activities, they are often denied long-term disability insurance. For this reason, the time to apply for and obtain long-term disability insurance is before one becomes unable to perform routine daily tasks.
Insurance companies are sensitive to the over-exaggeration of one’s inability to perform the activities of daily living. Individuals who provide information that they need assistance to complete these routine tasks can expect the insurance company to investigate the validity of their claim. Some insurance companies engage in video or photographic surveillance when they believe an individual is falsely claiming continued disability to obtain ongoing payments. Individuals receiving long-term disability payments should not engage in any activity contradicting their assertion that they cannot complete the activities of daily living. Falsely providing information about the effect of a disability can result in a denial of the claim or worse.
Many people rely on disability insurance to receive much needed funds when they become disabled and no longer able to work. Without these payments, families can undergo extreme financial stress. Individuals who have been wrongfully denied payments under their long-term disability insurance policy can file a bad faith insurance lawsuit against their insurance carrier for failure to honor the terms of the contract. The first step in obtaining wrongfully denied disability insurance payments is to contact an experienced Pittsburgh disability lawyer who can determine the best legal course of action.
If you or a loved one has suffered an injury resulting in an inability to work, compensation may be available. At AlpernSchubert P.C., our experienced Pittsburgh disability lawyers have successfully brought breach of contract and bad faith lawsuits against individual and group disability insurance companies to obtain compensation for our clients. With offices conveniently located in Pittsburgh, our dedicated disability law attorneys handle Workers’ Compensation and disability claims throughout Allegheny County, Lawrence County, Washington County, and across Western Pennsylvania. To schedule a free confidential consultation with an experienced Pittsburgh disability lawyer today, call us at 412-765-1888 or 800-243-6095 or submit an online inquiry form.
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