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Insurance Question


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Sorry, this is a little off topic, but see if you can help.

I have disability insurance that pays if I am disabled due to illness or injury for more than 30 days. It is called "total disability insurance".

I was injured at my job as a firefighter on Jan 17. I was placed on light duty beginning Jan 20. I have been totally out of work since my Surgery Jan 31. I am to return to light duty and to physical therapy (projected) at the end of March.

The insurance company CSR on the phone states that my claim doesnt begin until I was TOTALLY disabled and unable to work at all. She says that since I was on light duty until Jan 30, I won't be paid for time before March 1. Since I will return to light duty at the end of March, I will get only 1 month of disability pay.

Light duty, according to the doctor, means no sitting, standing, walking, lifting, carrying and can work only when seated.

Now we come to my question.

My policy states:

"During the first year of disability, totally disabled or disabled means you are unable to perform substantially all of the material duties pertaining to your regular occupation and are under the care of a physician."

Am I wrong here in saying that I am not performing my regular duties as a firefighter while I am temporarily assigned to light duty? The CSR said total means I can't work at all, but I don't read the policy that way.

If I am right, do any of you know what I can do about this?

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That's the thing, I have 3 policies with them. An accident policy, medical bridge policy and the disability. Filed multiple claims with them. So far, they have paid me $1200 for this accident and the disability claim is going to be around another $2000-$3000.

IMO, insurance is nothing more than legalized gambling. Now, after all these years of paying premiums for all sorts of insurance (auto, renters, home, life, etc.) and not filing claims, they have to pay and they are trying to renig.

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It sounds like you have a 1 year Own Occupation policy. This would mean that if you are unable to perform your own occupation, then the policy would pay a benefit. The question comes in that you were still working and receiving compensation, during your light duty, so you were actually able to perform your job, although modified. Did you receive a reduction in pay for the time specified? To be disabled, you would have to not be able to work at your current occupation. Since you were working, even on lite duty, I believe you were not considered Totally disabled. This is just my opinion, and is not legal advice.

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I could see that, except it doesn't mention in the policy about what wages I am getting. It says "ALL OF THE DUTIES".

This insurance company sold this to employees as a supplement during a benefits meeting back in December. I will make sure that all of the employees find out about this. They will lose customers over this, I promise you. Most of the people who bought it were cops and firemen. We bought it because we do get injured on the job quite frequently.

Our employer FORCES us to come to work if injured on the job unless the Dr says no duty. They assign you to administrative duty, to limit worker's comp claims and keep premiums lower. Admin duties usually consist of make-work, light clerical or even stressful television watching, anything as long as you are "at work" and not filing claims against the City's insurance carrier.

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