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Marsha411JD
Marsha411JD, Lawyer
Category: Consumer Protection Law
Satisfied Customers: 19773
Experience:  Licensed Attorney with 29 yrs exp with Consumer Law issues
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I have had a privately paid personal disability policy since

Customer Question

I have had a privately paid personal disability policy since 1987. I have never had a claim against my policy. I am presently out of work with a broken foot and cannot perform my current job as a dog walker. This is my 3rd month of being laid up. My policy was to kick in after 2 months of being out of work. My first response has been refused by MONY, Inc. stating that I had to work a minimum of 40 hours a week. The paper I signed when renewing every year was a 30 hour work week. I am a dog walker. A lot of payments are in cash and have not yet been reported yet. I actually have no pay stub that states how many hours I work. Do I have any recourse? I am furious that I have been paying this policy for 38 years and the first time I try to rely on it, I am denied. Thank you.
Submitted: 1 year ago.
Category: Consumer Protection Law
Expert:  Marsha411JD replied 1 year ago.

Hello,

Thank you for the information and your question. If you have appointment records that could be confirmed if necessary with your clients, then you might have a good chance with your appeal. The policy terms and what you signed are the controlling documents, so whatever they say as far as hours and proof are enforceable as the contract. So, if you have signed a document that says 30 hours a week and you have the appointment records and backup to prove you did work that many hours, then you should appeal and if your claim is denied you have two choices. One is to find an attorney to file suit for bad faith denial for you and the other is to first file a complaint with the Massachusetts Department of Insurance for the bad faith denial and then if they cannot resolve it, to hire the attorney I mentioned.

As an aside, it is important as a sole proprietor for these and tax purposes that you keep really good records of your hours and receipt of payment. If you don't then issues like this and an IRS audit could cause problems for you. I understand the cash payments and that is fine, but without receipts for those payments and appointment records it is very difficult to establish your hours.

Please feel free to ask for clarification if needed. If none is needed, then if you could take a moment to leave a positive rating in the box above, I will receive credit for assisting you today. Thank you.

Expert:  Marsha411JD replied 1 year ago.

Hello again,

I wanted to touch base with you and make sure that you did not have any follow up questions for me from the answer I provided to you on the 27th. For some reason, the Experts are not always getting replies or ratings (at the top of the question/answer page you are viewing or in the pop up box for this question), which is how we get credit (paid by the Site) for our work, that the customer thinks have gone through. In your case I received neither. If you are having technical difficulties with reading, replying or rating, please let me know so that I can inform the Site administrator. Please note thatSite use works best while using a computer and using either Google Chrome or Firefox.

In any event, it was a pleasure assisting you and I would be glad to attempt to assist you further on this issue, or a new legal issue, if needed. You can bookmark my page at: http://www.justanswer.com/law/expert-marsha411jd/

Thank you.