Unlike group long term disability policies that are offered through an employer (and must be litigated in federal court), Chubb policies are generally individual policies targeted toward specialty professions ranging from chiropractors to dentists. This can make these policies a little different from standard long term disability policies, and claimants must proceed quickly and efficiently when seeking disability benefits from Chubb. Below, we’ll discuss what claimants should be able to expect when submitting a disability claim to Chubb and why filing a lawsuit isn’t always the best idea in these cases.
GREGORY DELL: Hi. I’m Greg Dell with attorneys Dell and Schaefer, and I’m here with attorney Cesar Gavidia, and we’re going to talk about the Chubb disability insurance claims. Now, Chubb is a big company that sells lots of different types of insurance, but this is specific to their short and long-term disability insurance claims. But mostly, we’re going to focus on the long-term disability insurance claims because those are the ones where we’ve helped the most people, and it’s probably more of what they sell is the long-term disability than the short-term.
But in this video, Cesar, I want to give an overview. We’ll talk about our experience in working on these claims and how we’re able to help people– whether it’s an application for benefits with Chubb, ongoing claim handling if they’ve been denied, whether they need to do an appeal, because there is– most of these are private disability policies, but there could potentially be a group of very, very rare situation with Chubb– and then, of course, your experience in litigating these claims. So let’s start overall in terms of the types of policy language that you’re seeing from these Chubb disability policies.
CESAR GAVIDIA: So when Chubb went out to sell their disability products, they were primarily focusing them on professionals– dentists, chiropractors, people in occupations that were somewhat specialties or specializations. So what you’ll find in a lot of these policies is own occupation-specific language– in other words, language that states, if they are unable to perform the substantial material duties of their occupation, they’re totally disabled, meaning they could go and decide they’re going to do something totally different.
They could be a painter. They could be anything else. They could be a consultant. They could even be a business manager. If they’re not performing dentistry, or they’re not performing surgeries, or they’re not performing manual adjustments– whatever that their substantial material duties are– then they’d be totally disabled under these policies.
So that’s the specific type of total disability language you’d find in there. You’d find also very strict notice of claim language, meaning that, if you have a claim, you have a certain amount of time to get it in to Chubb or to the insurance company before they may consider you to be filing in an untimely manner. So I’ve come across some cases where people file the outside four, five, six months outside of that 90-day window, and Chubb tasks– or the administrator for Chubb asks– well, why did you file it. It’s only three or four months out?
We’re not talking about years out. We’re just talking about a few months. So they seem to adhere– at least their administrators– and we’ll talk more about their administrators, I’m sure, as the video goes on. They seem to adhere very strictly to that notice of claim language as well. You’ll also find, in terms of the maximum pay period of those policies– the base option or the base-level policy– you’ll find age 65 in the sense of the term of the policy. And then sometimes you’ll also find that these policies provide you with lifetime benefits, if you’ve purchased into that option, that would pay you benefits, obviously, for lifetime if you’re totally disabled by, say, age 55 or age 60.
GREGORY DELL: But Chubb’s not new to writing these disability policies.
CESAR GAVIDIA: No, no. In fact, they’ve been writing them for a long time. So a lot of the policies and claims that I see today are on policies that are from the ’90s, from the ’80s.
GREGORY DELL: Wow.
CESAR GAVIDIA: …some even older than that.
GREGORY DELL: So you’re talking 30-plus years ago that they’ve been–
CESAR GAVIDIA: Yes.
GREGORY DELL: –been writing disability policies. OK. You did talk about administrators, and what did you mean when you said that, in terms of how a claims handled by Chubb?
A Third Party Claim Handler Reviews and Administers Your Chubb Disability Claim
CESAR GAVIDIA: So Chubb doesn’t handle their claim anymore. In fact, I believe a large block, if not the entire block of their individual disability insurance business was bought by a company called the Lincoln National Life Insurance Company. And we’re very familiar with Lincoln because we see them on the ERISA group disability claims. They seem to have a large section of that market, especially now that they’ve bought Liberty Life Assurance Company of Boston.
So we see Lincoln everywhere in terms of group employer provided policies. Where you don’t see him too often is in the individual disability products, but they’re there. They’re there in the Chubb block of business. And Lincoln doesn’t actually administer these claims themselves. They hire out to a company called DIS, or Disability Insurance Services, to do their third-party claims handling.
And we’re we’ve seen them before isn’t a lot of Lloyd’s claims, who also do the same thing. And other insurance companies do that. They hire out to third– this third-party Disability Information Services– DIS– to do their claims handling. So they don’t do it themselves.
GREGORY DELL: And do you end up suing DIS if there’s a problem, or do you– if there’s a denial, or do you sue Chubb?
CESAR GAVIDIA: I’m sure that there’s– depending on the state, because you’re filing a breach of contract action, or a state law cause of action under the laws of your specific state when they refuse to pay you, I’m sure there’s sometimes creative ways or causes of action that you could bring against a third-party administrator. Some people think maybe tortious interference with a contract.
That doesn’t always hold up in all the states and everywhere you can potentially bring a lawsuit against Lincoln, but generally, no. Generally, you just sue the payer of the policy– the owner of the policy, which is the Lincoln National Insurance Company in this case.
GREGORY DELL: So almost all of the Chubb policies are ERISA exempt, which is great, which means a person’s going to end up with their right to a jury trial and everything that goes along with that, as opposed to being stuck with this appeal process. But with regard to if there is a denial from Chubb, is there any kind of appeal process before you file a lawsuit that’s available?
CESAR GAVIDIA: Not really– not that I’ve seen. What they’ll do is– and what we’ve seen a lot of other companies do as well is they’ll say, well, if there’s additional information want us to consider, we’ll consider it. It’s not an appeal in the sense that it then goes to a separate person, or a separate claim reviewer, or another doctor that they select to review the medical information you’re submitting.
It basically goes back to the same people that just made the decision to deny your claim. So you don’t really get a sense of an independent review. You’ve already had this claims examiner who’s already made a decision, who already has this preconceived decision that you’re not entitled to benefits reviewing this additional information that you have submitted that’s unlikely to change their mind. So there’s no formal appeal process.
GREGORY DELL: Without a formal appeal process, I know there are situations where a client contacts us, they’ve been denied, and they’re ready, gung-ho to file a lawsuit. And we’d love to file lawsuits and really go after the company if they’ve done a wrong denial, but what are the situations when you say, let’s not sue right away– let’s get some additional information? And why would you recommend that to a client?
A Disability Insurance Lawsuit is Not Always the Best Option for a Client Seeking Disability Benefits
CESAR GAVIDIA: Well, we’d love to think that every legitimate claim is perfectly submitted. All the medical records say exactly what they should say. Your doctor’s opinions and the way they’re filling out your attending physician statements is exactly what they should be doing and exactly how they should be completing everything. But that’s not always the case.
Sometimes you find that your doctor isn’t cooperative, or sometimes you find that your doctor doesn’t really understand what it is you’re asking of them. So you may need to go back to them and say, doctor, what do you mean by this, or doctor, can you help me with this so that you can accurately express or reflect what my limitations are, or what my physical problems are, and why I can’t work? This is the claim I’m submitting to the insurance company, and they find that there’s not very clear information here.
So sometimes you want to take advantage of that. And then also, if you find yourself in this– I guess you could call it in the adversarial unfortunate situation of being denied– and they’re telling you that there’s additional information could submit, you could consider doing a vocational assessment if there’s some question in terms of your occupational duties, or the physical demands, or functional demands of your occupation.
You could submit for review by your own independent medical examiner, somebody that you go out and find yourself or that your lawyers find to do a complete physical examination of you to assess your physical functional limitations and problems you have– those things that prevent you from performing the substantial material duties of your own occupation.
GREGORY DELL: So switching gears and going back a little bit– because we touched on a little bit about filing a lawsuit and maybe not being ready– but how do you assist the claimant during the stage of filing for benefits?
Disability Insurance Attorneys Dell & Schaefer Help Claimants Apply for Benefits
CESAR GAVIDIA: Well, as we were saying when we were talking about the– there may be something that is need some further clarification or they need– your doctor may need to expand on something in terms of the attending physician forms, these forms are really important, and so are these initial claim applications that you’re submitting. All of this information is being thoroughly reviewed by DIS or by Lincoln.
So in terms of how you express what your occupational duties are, it’s not just simply saying, I perform general surgery or I perform general dentistry. You have to get down to the substantial material duties, and what they involve, and the instruments you use, and how much perhaps dexterity is needed to do some of the things that you do, if you’re having problems in your hands, or in your upper extremities, or in your neck.
So those are the types of things that we assist in crafting and expressing in these forms that are extremely important, because in some of these policies, when they describe what proof of loss is, it’s what you express in these forms specifically, and the information you’re conveying to them through these forms– so also going back to what your doctors are putting into their attending physician statements and them understanding what it is that needs to be expressed to the insurance company so that there could be this accurate portrayal of what your claim is, and what you’re seeking, and the limitations that you’re experiencing that prevent you from working in your occupation.
GREGORY DELL: Right. So mean filing the lawsuits against Chubb on these denials is second nature for us, and it’s a specialty that we have. However, there’s so many claimants that we’ve helped to apply for benefits and then maintain their benefits, which prevents claimants from having to possibly get– or helps prevent a claimant from having their claim denied and then not having to file a lawsuit, which is a super important service that we offer– which is also unique, because a lot of lawyers only want to deal with a denial, and they don’t want to deal with a– helping a person stay on claim, or applying for that matter.
Because the attorney fees are significantly different as well from when a claimant’s denied versus a claimant who’s calling and say, hey, Cesar, can you help me apply? Can you keep me on claim? And we love representing the people early on, and keeping them on claim, and avoiding the– what we often find are little mistakes or lack of medical documentation that resulted in that claim denial. And I often find that 9 out of 10 times, it’s something that could have been avoided if the claimant had properly prepared their Chubb claim. What is your take on being prepared?
CESAR GAVIDIA: Yeah, I think it’s absolutely critical in terms of a claim with Chubb– particularly with Chubb. You have this third-party administrator that wants Chubb to be or Lincoln to be very happy with them. And they don’t want to lose that business. That’s a very lucrative client for them. So you can bet that what they’re doing is going every– going through absolutely everything you’re submitting to them with a fine-tooth comb, and if everything is not very specifically and very accurately expressed in your attending physician statements, in your claim forms, in your medical records, in the financial reports that you’re submitting to Chubb, then they’re likely going to find some way or some reason to say, doesn’t seem like your production dropped off.
We have questions over what you’re claiming are substantial material duties of your occupation. We only find that you did 100 of these procedures compared to 1,000 of these other procedures that you did last year. So they start getting into the forensic details of your occupational duties, of your income. And so without the proper guidance, you could stand to be potentially in trouble with them.
GREGORY DELL: Right. Or they say, you treated with a doctor for a year, or two, or three years, and you kept working. Why all the sudden did you stop? And the records don’t necessarily reflect the need for you to stop, so what happened?
CESAR GAVIDIA: Yeah.
GREGORY DELL: You see that a ton. So there’s so many different aspects with the Chubb claims. The important thing for someone who’s watching this video and considering our law firm is that we have extensive experience in handling these claims. And whether you’re considering filing– you need help with your claim because you’ve been denied– no matter what stage it is, whether it’s Cesar or myself, we’re readily available to help you.
The most important thing for you to do to get going is to send us a copy of your disability policy. If you’ve been denied, send us a copy of the denial letter. You can call us through the toll-free number on the video you’re watching, or go to our website at diattorney.com and submit a free consultation. Upon receiving that, one of our lawyers will immediately call you.
We will review all of your information and we’re going to let you know right on the phone how we can help you, what we think are your chances of success, how we’re going to charge you– which very often is a contingency fee basis, which means you’re not going to owe us any fees or costs unless we make a recovery for you. Now, we hope that you find this video helpful.
And we have a very active YouTube channel, which we welcome you to subscribe to, in which we talk about not only Chubb, obviously, but all the disability companies. And we often provide helpful tips, which we think you should find helpful for maintaining your disability claim or helping you to get back on claim. All of our clients are located all over the country, and whenever you need us, we’re here and ready to help you.
As you’ve heard, handling a Chubb long term disability claim can be a complex process. Don’t go into it alone – let the experienced team at Dell & Schaefer help. We’ve helped thousands of long term disability claimants recover their benefits and are well-versed in what to expect from the disability claims process. All we’ll need to get started on your claim is a copy of your long term disability policy (and, if your claim for disability benefits has been denied, a copy of your denial letter). Give us a call today to schedule your FREE initial consultation with one of our attorneys.