• David Martin

What’s in Your Disability Plan?



Remember the Capital One® commercial, “What’s in Your Wallet?” It is also important to know what is in your disability plan, since it will affect your wallet.

Many of us never think we will be unable to work. However, every day we are only one accident away from that. If you have a plan, you need to know what is in it. If you don’t have one, you are risking more than you may realize.

The Middle District of Florida recently was looking at a plan – a FedEx plan. We have previously noted that this plan is one which will rarely ever pay. This proves true again. This plan gives Aetna discretion to make all findings of fact and to make all interpretations of the policy. A court can only disturb that if Aetna’s decision is arbitrary and capricious. An employee, a senior business systems adviser, found out the hard way how illusory this plan really was. One of the onerous terms was proving disability based on an inability to engage in any employment for a minimum of 25 hours per week.

Generally, people think a disability policy covers the income earned during their normal work week and not at a greatly reduced schedule. And certainly, they think they are covering their wage. That is the point of a disability policy – to provide income replacement. In this instance, however, an infralimbic thromboembolism, COPD, emphysema, blood clots, depression, hypertension, hyperlipidemia, obstructive sleep apnea, obesity, and irritable bowel syndrome were not enough to prevent Aetna from finding Ms. Street capable of working 25 hours a week.


Aetna hired Dr. Cosmo to examine the plaintiff, which is often a policy right for the insurance company. The doctor often is someone the insurer regularly uses for this. The doctor found on this one-time exam, that Ms. Street could work a sedentary occupation for at least 25 hours a week. This was due in part to the lack of “significant objective findings.” That is another plan term that can be very difficult to overcome for a claimant, since pain and fatigue are very often subjective. Providing “objective proof” of pain or fatigue as defined by that policy may not be possible.


To preserve her function, the plaintiff exercised by swimming. The court said Aetna was correct to take that activity into account, along with other activities she engaged in to preserve her remaining function. If she could do laundry, prepare meals, and take afternoon swims she could work 25 hours per week. The Court ruled for Aetna.

This underscores that everyone needs to take a few minutes to read their policy. Too busy? For me the perfect time is in a waiting room or during an oil change. If your long-term disability policy is worthless, find a replacement that covers your needs. Don’t find out when it is too late that you are banking on an illusion.

#ERISAdisabilitylawyer #longtermdisabilityinsurance #longtermdisabilitylawyer #longtermdisability

Contact us today for a free initial consultation.

The Martin Law Group is dedicated to being your go-to ERISA attorneys and long term disability lawyers. Whether you are pursuing a long-term disability claim, life insurance benefits, or your pension or retirement benefits, we will meet with you face-to-face to discuss your claim at a location convenient for you. 

 

In an effort to make disability claims as easy as possible, we offer a free initial consultation. We often work with clients in Huntsville, Mobile, Birmingham, Montgomery, Dothan, Tuscaloosa, and Florence, in Alabama, as well as with clients in Columbus, Meridian, Jackson, Hattiesburg, Tupelo, and Gulfport, Mississippi, and surrounding areas.

Contact us today for a free consultation.

Long term disability attorney
Long term disability lawyer alabama

Tuscaloosa Office

2117 Jack Warner Pkwy
Suite #1
Tuscaloosa, Alabama 35401
Toll-Free: 800-284-9309
Local: 205-343-1771

Birmingham Office

The WSK Building
2323 2nd Avenue North
Birmingham, Alabama 35203
Toll-Free: 800-284-9309
Local: 205-343-1771
  • Long term disability lawyer
  • ERISA disability lawyer
  • Retirement benefits lawyer

© 2020 by The Martin Law Group, LLC

Sitemap | Legal Disclaimers | Privacy Policy

Website proudly created by Cartography Consulting.

DISCLAIMER: The information presented on this website should not be construed to be formal legal advice nor the formation of a lawyer/client relationship. Therefore, no information of any kind that you provide us before such a relationship is created is confidential or privileged.

Furthermore, no representation is made that the quality of the legal services to be performed is greater than the quality of legal services performed by other lawyers.