Lloyd’s of London is known for insuring famous athletes and celebrities, But Lloyd’s of London policies aren’t just limited to celebrities, Lloyd’s of London also carries “regular” insurance policies for high level professions as well, providing individual policyholders with supplemental long term disability insurance. If you’re considering submitting a disability insurance claim to Lloyd’s of London or recently have received a letter denying your claim for long term disability insurance benefits, Dell & Schaefer can help. Read on for some of the tips we’ve learned while helping clients recover disability benefits from Lloyd’s.
GREGORY DELL: Hi, I’m attorney Gregory Dell. I’m here with attorney Cesar Gavidia. And today, we’re going to talk about Lloyd’s of London, and specifically applying for a long-term disability benefits with Lloyd’s of London. Now, Cesar, you know that Lloyd’s of London is one of the– usually called an excess disability carrier, because they usually write policies above the standard issuance that you can get from other disability carriers.
But Lloyd’s of London policies are usually unlike any of the other disability policies that we see. So today in this video, I want to review their policies, in particular what’s unique about them. But more specifically talk about what a person who is considering filing for disability, or in that process needs to know so that they can get approved. And also, how they can work with our law firm to help achieve their goal of getting their claim approved. So let’s start first with, what do you find is the most unique thing about a Lloyd’s of London disability policy?
CESAR GAVIDIA: Well, the first thing that always stands out is usually their term. In other words, they’re not policies that, if someone necessarily becomes disabled at age 50 or 55 is going to pay them for lifetime or for you know, to age 65. Usually, they have a term of a limited number of years. It could be five years. It may be a little more.
All those things depend on the premiums and the things that– what they underwrite you for. But it’s usually for a set period of time. Also, the premiums that one usually pays, because as you had said, these are excess policies or surplus policies– you’re already going beyond what your typical financial underwriting would get you or perhaps you have some sort of pre-existing medical issues or you have advanced age. So this is the type of policy that you’ll be able to obtain, but you’re going to pay a very, very hefty premium for.
GREGORY DELL: And a lot of our clients have been professional athletes from all of the major sports, doctors, high-level business owners, executives of companies. So we’re very familiar with the nuances of the policies and the sophistication of our clients when having these types of policies. Let’s talk about the definition of disability that we commonly see in these policies and why it’s so important to understand that when applying for benefits with Lloyd’s of London.
CESAR GAVIDIA: Sure, so typically, a Lloyd’s of London policy will provide you with total disability benefits in the event you become totally disabled in your occupation. But usually, it also requires that you not be gainfully employed in any other occupation. So it means basically, total disability, although from your occupation, unable to perform your substantial material duties, but you can go off and do something else, another type of profession.
Lloyd’s Disability Policies Have Very Specific Policy Terms That Are Strictly Enforced
Also, something that’s unique to some Lloyd’s of London policies, not all of them, you have to establish a permanency to your disability. It’s not true to all Lloyd’s of London policies. But I’ve come across them in a lot of policies.
And for us, as disability lawyers, if we’re helping someone with their application or someone who’s applying with Lloyd’s of London for a disability claim, you know, and they’re having their doctor’s complete forms. They’re going to come across this really important question about permanency. And they may think, well, you know, who knows– it’s not so important whether it’s permanent or not. It’s just important that I’m disabled now. Well, that’s not true with all Lloyds of London policies. Your doctor has to state that you’re permanently disabled, your condition is never going to improve, and you’re never going to be able to return to your occupation.
GREGORY DELL: And we’ve seen different Lloyd’s of policies where some have a one-year elimination period. Some are 180 days. Some have been two years that you have to be permanently disabled, not returned to work. And usually, the longer duration periods result in what’s a lump sum payment.
Lloyd’s of London Will Always Use A Third Party Administrator to Handle the Claim for Benefits
We’ve also seen them where they’re business buyouts between partnerships. And those usually require at least a year of being unable to do the duties of your occupation. So when applying for Lloyds, what’s very unique is that when we usually do applications for most other carriers, we know who the claims person is going to be or the third-party administrator that’s going to handle the claim. How is it unique with Lloyd’s, once you submit a claim in terms of who’s actually going to review the claim and make a decision?
CESAR GAVIDIA: So they use a third-party administrator, all right. And what that means is a company that Lloyds will hire out to, to do the claim review, basically obtain all the medical records, obtain all the statements, you know, do all of the investigation to determine if there’s any liability– if there’s liability, and then make the decision to pay the claim, or the recommendation to pay the claim to Lloyds. They use a couple of different companies.
In the past, I’ve dealt with DIS, Disability Insurance services. And most recently, I’m dealing with a company called McLaren’s. Now, most of these people have you know, various levels of insurance certification.
But they aren’t necessarily specialists in disability insurance, like you might find with representatives that a Unum or a MetLife or one of these other– Prudential– one of these other disability insurance-specific insurance companies. They’re more you know, certified or specialized in dealing with different types of casualty loss claims and policies. And of course, they understand disability insurance, or at least the products that they’re evaluating for Lloyd’s. But it’s not like it’s usually the only thing that they’re doing or working on as you would see with another disability insurer.
GREGORY DELL: And it’s unique for us as attorneys when we talk to clients and say, well, what are the chances I’m going to get approved? You know, that obviously varies based upon the facts and circumstances of their case. But a lot of times, we’ll say, well, it depends who they’re going to assign to handle the claim, because it’s different every time. You know, we don’t know who you’re getting. It’s hard to build a rapport with someone internally.
Now, obviously, the uppers at Lloyd’s know our law firm, because we’ve pursued many cases against them and represented lots of clients. But they’re fluctuating who they’re going to have to handle, because they’re a business Lloyd’s, like a conglomerate of different investors and insurance companies basically out of London. And they put together these groups to sell these policies. And then they worry about administering them later.
CESAR GAVIDIA: Right, and if you think in terms of the risk, right, some of these policies, and a lot of the ones that I’ve dealt with have a term of five years, meaning that the total lifetime coverage this policy would give you is five years. So say you purchased one today, we’re in 2020, by March, 2025 that policy ends, whether you’ve submitted a claim– well, if you don’t submit a claim in that time, that’s it. That’s all the coverage you have.
So you may be paying $20,000, $25,000 a year in premiums. That might be $100,000, $125,000, or whatever it may be over five years. And you would not have a claim. But it’s usually for, like we were saying, high-risk insureds, high-risk ages, high-risk medical issues or pre-existing medical issues, or high-risk occupations like some of these professional athletes like NFL players, hockey players, those types of professionals.
GREGORY DELL: OK, let’s get into some tips for getting your Lloyd’s of London claim approved. Let’s go, first of all– forget about a pre-existing condition evaluation, which is obviously important to determine if you had a medical condition within 12 months of getting the policy or something you didn’t disclose, which could preclude you from coverage. Obviously, we’d look into that. But assuming the pre-existing condition provision is satisfied, we’re not worried about that, what’s the most important thing a person should know when they want to get a Lloyd’s claim approved?
CESAR GAVIDIA: I’m going to tell you just from my experience in dealing with the claim applications with Lloyd’s of London. And you know, of course, we recommend that you hire an attorney whenever you’re thinking of applying. But the Lloyd’s applications are extremely detailed, and they ask so many questions compared to other applications that I’ve encountered.
And these questions are very specific to terms and things in these policies, these little nuances, things that are different about these Lloyd’s policies that you don’t see in other disability insurance claims or policies. And you know, a lot of these people who have Lloyd’s policies have other coverage as well. So they think well, my doctor’s stating this on my Unum attending physician statement. He’s going to state the same thing on the Lloyd’s attending physician statement.
But what’s good for Unum, I could almost assure you it’s not going to be good for Lloyd’s. And so one of the most important things, if you have a Lloyd’s policy is you should definitely consult with an attorney who specializes in dealing with disability insurance and specifically, Lloyd’s of London policies. Aside from that is you have to pay extremely close attention to these application forms that you’re completing for Lloyd’s. Because like I said, they’re very detailed. And the questions are really, really specific.
And you have to know the insurance policy terms and conditions inside and out. These are different policies from the typical disability insurance policies. And I can assure you from the disability insurance policies that you might have had in place for 20 years, you’re not dealing with the same animal. This is a very unique product.
The Medical Support Must be Documented with Specificity to Meet the Policy Terms
GREGORY DELL: All right, let’s talk about medical support. Medical support is essential. We always say, if you don’t have strong medical support, your claim’s never going to get approved.
But we look at every claim because we’ve been through the whole cycle from approval through denial and then litigating a case to see where it’s going to go. Lloyd’s has an interesting process if the claims approved. Usually, they have these arbitration slash medical review provisions in the policy where you can’t even necessarily get a jury trial, where at the end of the day, they’re going to have their medical person look at it. You have your medical people look at it.
And then if you don’t agree, there’s going to be a neutral person who’s going to look at it. And sometimes that neutral person has the end-all, be-all say. That being the case, what kinds of tips do you give to someone who’s applying in terms of getting strong medical support?
CESAR GAVIDIA: It’s extremely important, because the medical support, not only has to be strong, but has to be strong to fit the specific terms and requirements of this Lloyd’s policy. Your doctor may say, of course he’s totally disabled. He could never perform surgery again. They could never perform surgery again, or they could never be a professional football player again.
But if they don’t stay– in your particular policy, the permanency requirement may be there– if they don’t state that the disability is permanent, if they don’t state that there’s no way to resolve it, if they don’t say that there’s no chance that surgery is going to somehow resolve and cure this problem for you, then you’re not going to get approved if your policy has that specific requirement. So you know, the medical support is important, but it’s more important that your medical support is fitting the specific requirements of these policies.
GREGORY DELL: Right, so I feel like what you’re saying is it’s easy to make a mistake early on. And also, I feel it’s very important to a Lloyd’s policy to gear up with as much ammunition and support that you can. So don’t just rely on one doctor. If there’s two or three doctors that are specialists or sub specialists of your medical condition, go and treat with those doctors, get consoles, be patient in submitting your Lloyd’s claim.
Because we always say, most of these claims aren’t like somebody– you know, you break your leg. You have a catastrophic injury. Those claims aren’t that hard.
CESAR GAVIDIA: But you know, it’s a very delicate dance, because you could have three doctors, three specialists, but you also have to make sure that they’re all saying the same thing. OK, sometimes I tell my clients– they think, well, I have three or four specials. I say, that’s fantastic. That’s great that they all support you.
But they have to continue supporting you. They have to continue saying the same thing throughout the lifetime of your client. It’s a lot to manage. It’s very difficult, and it’s a delicate dance, like I said. Because if even one of them goes off course or doesn’t cooperate or says the wrong thing or puts the wrong thing in the medical records, that’s going to potentially throw off the entire claim.
GREGORY DELL: Right, so again, that all goes into the planning and how you submit the application. And then also when you’re treating with doctors, Lloyd’s is going to dive in and pick on any mistake in the claim records or anything they think can show a lack of support for the claim. You know, you talked about the great detail in these applications that’s required.
But also, you have to show what the occupation was. Because they’re almost always unable to do the duties of your own occupation. And you know, how do you go about presenting the person’s occupation beyond just what the claim forms ask?
CESAR GAVIDIA: Right, so you have to kind of really dig in to what the occupational duties are. You have to go through almost a forensic analysis of this person’s occupation, because that’s what Lloyd’s is going to do. They’re going to get through to the very specific minutia of what you’re doing.
And you want them to know how you know, perhaps intellectually demanding your occupation, or how physically demanding it was, or a combination of both. And you really delve into that when you start to you know, provide a real thorough and complete description of what your occupational duties and substantial material duties are to Lloyd’s.
GREGORY DELL: And I know when we submit the applications, we do a fairly detailed supplement to the application, which is actually pages that we draft where we say, this is the occupation. And we highlight what’s important so that we’re anticipating what Lloyd’s is going to do in terms of how they analyze the occupational duties. So you know, the purpose of this video is to make people understand that there’s a lot of nuances, a lot of areas that potentially make mistakes here, and a lot of things that you can relatively easily avoid with proper guidance so that you can get your claim approved. And that’s the type of service that we offer and the type of advice that we’re trying to let people know about here.
So whether you contact Cesar or myself, we’re always going to offer you a free initial consultation to review your Lloyd’s policy. What we ask is that you give us a call. Our phone number is listed on this video, on our website.
You can also go to our website, at diattorney.com and submit a free consultation, which will come as an email to one of our lawyers. We’ll call you back right away. Once you send us your policy, we’ll review it for free. We’ll get on the phone with you. We’ll let you know how we can help you, or what we think is a weakness in your particular claim.
We represent claimants all over the country. And we appreciate you considering our law firm.
We hope this has helped ease your mind a bit when it comes to applying for long term disability benefits with Lloyd’s of London. Trying to navigate this process without an attorney can be an extra source of stress during an already-fraught time, and having some legal advice (and experience) in your corner can make a major difference. If you’d like to get started on your Lloyd’s of London long term disability insurance claim or appeal a denial of disability insurance benefits, get in touch with Dell & Schaefer today to schedule your FREE consultation with a member of our legal team.