Legal

Ask a Lawyer and Get Answers to Your Legal Questions

Ask a Lawyer,
Get an Answer ASAP!

Legal
This answer was rated:

My husband has been receiving total disability benefits from

My husband has been receiving...
My husband has been receiving total disability benefits from a policy he personally paid into for 16 years. In the policy it states maximum benefit period .. Your lifetime if disability commences before your 55 th birthday. His total disability - a brain stem stroke happened when he was 51. At the time that the disability claim was approved his underwriter told him that they do not even write these types of policies anymore, but that he qualified based on his injuries and 16 years of paying to keep the policy in force all those years out of pocket, instead from the GI practice. He was a GI dr and surgeon. However the stroke left him with depth of field problems among many other health issues that would preclude him from performing his duties as described and needed for the practice.

This past month we received a letter stating the insurance co was in the process of updating their medical files on him.They would appreciate if we would complete the enclosed information for, regarding all the medical history in the past 5 years and not just on his claim condition. In order for medical providers to release records a current dated authorization is required. The latest one they have on record was 5 months ago by his annual attending physician. Then in the authorization form it includes the following: entire patients medical record, non medical information about him, education, occupation, employment history earnings, finances, eligibility for other benefits. Social security info including detailed info regarding earnings for up to 10 years and a summary record for total earnings . He is collecting no other disability benefits. He is not collecting social security of any kind deferring it till the age of 70. He is now 65. Our understanding is that the request for tax records is a violation of ones constitutional rights to privacy. The monthly benefit amount is fixed and was based on his 3 highest earning years back when the disability happened in 1997. The definition of total disability is if he is not able to do the substantial material duties of his regular occupation , such as endoscopy surgery at the time of the disability. Does the insurance company have the right to ask for items other than those medically related? I i.e. tax returns employment status education finances. Employment history and social security info? What are my husbands rights to all this confidential info? Are they on a fishing expedition to drop him, and should we seek counsel of a disability insurance attorney?
Show More
Show Less
Ask Your Own Legal Question
Answered in 19 minutes by:
8/16/2012
TexLaw
TexLaw, Attorney
Category: Legal
Satisfied Customers: 4,430
Experience: Lead trial/International commercial attorney licensed 11 yrs
Verified
Hi,

Thank you for your question.

Your tax information is protected by your constitutional rights to privacy unless that right is abrogated by contract (i.e., you give someone permission to see it), or if you put your income at issue in an adversarial legal proceeding.

Under a disability policy such as the one you are referring to, the policy requires that you cooperate with them in connection with any claim submitted. Further, because the nature of the relationship between insured and insurer is one of contract, the company is not in an adversarial position to your husband that would trigger a constitutional privacy protection. In other words, the insurance policy provides the insurance company with permission to look into this type of information.

The type of information that the insurance company is requesting is related to the nature of the disability claim. A disability claim is not only associated with the actual medical disability suffered by your husband, but also concerns the calculation of benefits due to him which is based in part on his prior income. Thus, they likely have a legitimate interest in obtaining the information. Also, you do not want to endanger an assertion by the insurance company that you have failed to cooperate, which will trigger their rights to terminate the benefits.

That being said, the insurance company is definitely undertaking a review of your husband's claim. They are looking for any information that will allow them to reduce the benefits. Unfortunately, they are most likely entitled to this information pursuant to the insurance policy. If there is any information out there that would trigger a reduction, such as a miscalculation of his earnings, then the insurance company is entitled through the policy to be able to review the information to make a determination.

You will need to comply with the waiver request. If the insurance company decides to change your benefits based on any of the information provided, then you will want to contact a disability insurance attorney to protest the negative finding on your claim. However, at this point, you are required to comply with the information request.

-ZDN
TexLaw
TexLaw, Attorney
Category: Legal
Satisfied Customers: 4,430
Experience: Lead trial/International commercial attorney licensed 11 yrs
Verified
TexLaw and 87 other Legal Specialists are ready to help you
Ask your own question now
Customer reply replied 5 years ago
The tax info they are requesting is forvthevpast 10 years. Well after the disability claim was accepted and processed. The amount he receives was based on his 3 highest years prior to te disability.

You mean they can still look at what Hess made in the past decade after he had to recreate himself after he gt over the major depression of having his career taken away from him by a stoke.. 15 years worth of medical training which he could no longer perform? Thank you
The right to disability benefits under an insurance policy turns on whether the individual is disabled. If an insured became disabled in one line of work, but then retrained and was able to do a different type of work, then the disability benefits may be reduced under the policy as the person is no longer considered disabled. In your husbands case, if he has retrained himself and started earning money in a different profession, there is the possibility that this would affect the right to continued benefits. There is also the possibility that the insurance company could attempt a fraud claim against you.

If your taxes will show that your husband was earning money from a different source of work, then you definitely need to retain counsel. If there is information in the tax record that could hurt your right to the disability benefits or could trigger an insurance fraud claim, you will want to resist disclosing that information or limiting the fashion in which it is disclosed. I'm not trying to say that there is a fraud claim against youas obviously I don't have the full picture of what is going on, but you need to take these things into consideration.

That being said, the insurance company is entitled to review your husband's status as disabled by looking at this type of information. An attempt to prevent the disclosure of the information needs to be done very very carefully so as not to draw any unwanted attention or trigger the non-cooperation clause which will cancel the benefits.

-ZDN
Ask Your Own Legal Question
Customer reply replied 5 years ago
This is a very special type of law. We will retain a disability insurance policy attorney. The policy was written back in the 70 s and is tax free since it was paid out of pocket by the individual and not the group. My hunch is that they will reduce benefits to residual, offer a settlement or try to claim him as whole and drop him altogether. In any case scenario, legal counsel should best be obtained. Thank you.
I agree. This type of policy is indeed very rare, so I think your decision to retain an attorney to handle the matter from here on out and give you specific legal analysis of your duties under the insurance policy is very wise.

I wish you good luck and hope that this turns out in your favor.

Best Regards,
ZDN
Ask Your Own Legal Question
Ask TexLaw Your Own Question
TexLaw
TexLaw
TexLaw, Attorney
Category: Legal
Satisfied Customers: 4,430
4,430 Satisfied Customers
Experience: Lead trial/International commercial attorney licensed 11 yrs

TexLaw is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

Mr. Kaplun clearly had an exceptional understanding of the issue and was able to explain it concisely. I would recommend JustAnswer to anyone. Great service that lives up to its promises!

Gary B.Edmond, OK

My Expert was fast and seemed to have the answer to my taser question at the tips of her fingers. Communication was excellent. I left feeling confident in her answer.

EricRedwood City, CA

I am very pleased with JustAnswer as a place to go for divorce or criminal law knowledge and insight.

MichaelWichita, KS

PaulMJD helped me with questions I had regarding an urgent legal matter. His answers were excellent.

Three H.Houston, TX

Anne was extremely helpful. Her information put me in the right direction for action that kept me legal, possible saving me a ton of money in the future. Thank you again, Anne!!

ElaineAtlanta, GA

It worked great. I had the facts and I presented them to my ex-landlord and she folded and returned my deposit. The 50 bucks I spent with you solved my problem.

TonyApopka, FL

Not only did he answer my Michigan divorce question but was also able to help me out with it, too. I have since won my legal case on this matter and thank you so much for it.

LeeMichigan

< Previous | Next >

Meet the Experts:

Tina

Tina

Lawyer

8,775 satisfied customers

JD, BBA Over 25 years legal and business experience.

Ely

Ely

Counselor at Law

24,353 satisfied customers

Private practice with focus on family, criminal, PI, consumer protection, and business consultation.

INFOLAWYER

INFOLAWYER

Attorney

20,727 satisfied customers

Licensed attorney helping individuals and businesses

JPEsq

JPEsq

Attorney

2,132 satisfied customers

Experience as general attorney, in house counsel, SSDI, Family Law attorney, and law professor

Law Educator, Esq.

Law Educator, Esq.

Attorney

42,358 satisfied customers

JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law

Ellen

Ellen

Lawyer, Consultant

8,238 satisfied customers

25 years of experience helping people like you.

Guillermo J. Senmartin, Esq.

Guillermo J. Senmartin, Esq.

Attorney

292 satisfied customers

7+ years of experience handling various legal matters.

< Previous | Next >

Related Legal Questions
My mother took out a life insurance policy on me when I was
Hi, my mother took out a life insurance policy on me when I was a minor. I'm 27 now, and found out she's refusing to sign the policy over to me despite the fact I'm an adult and her agreeing to over a… read more
LegalGems
LegalGems
Juris Doctorate
10,686 satisfied customers
I have both a homeowners insurance policy that covers damage
I have both a homeowners insurance policy that covers damage to our home with a $1000.00 deductible and a home warranty policy with a $1000.00 maximum for plumbing incidents. We had a slab leak (plumb… read more
Michael Bradley
Michael Bradley
JD
1,191 satisfied customers
My home insurance policy re: full replacement cost. Language
My home insurance policy re: full replacement cost. Language was confusing so I had some words with agent who got mad and told me to go shoping. So I did. On potential new agents screen it said my cur… read more
Law Educator, Esq.
Law Educator, Esq.
Attorney
Doctoral Degree
42,358 satisfied customers
My car insurance policy was canceled because I was
Hi, my car insurance policy was canceled because I was ill-informed is there something I can do? … read more
Law Educator, Esq.
Law Educator, Esq.
Attorney
Doctoral Degree
42,358 satisfied customers
A life insurance policy which was cancelled in October,
a life insurance policy which was cancelled in October, November, and December, and on auto-pay has still not ceased. what to do? … read more
Legal Eagle
Legal Eagle
Attorney
Doctoral Degree
7,340 satisfied customers
I am sold a insurance policy and I have a copy of the letter
Second opinion] I am sold a insurance policy and I have a copy of the letter of confirmation, the certificate of insurance, when claimed form is submitted I am told I was not sold the amount of insura… read more
Bill Attorney
Bill Attorney
law
1,585 satisfied customers
We need advice on universal life insurance policy. New
We need advice on universal life insurance policy. … read more
Legal Eagle
Legal Eagle
Attorney
Doctoral Degree
7,340 satisfied customers
I want to have a life insurance policy and add my fiancée as
I want to have a life insurance policy and add my fiancée as one of the beneficiaries. The Insurance company is asking me: "insurable interest exists/what financial loss will be incurred by the person… read more
Legal Eagle
Legal Eagle
Attorney
Doctoral Degree
7,340 satisfied customers
I am a grandfather who took out a life insurance policy for
I am a grandfather who took out a life insurance policy for my 19 year old … read more
INFOLAWYER
INFOLAWYER
Attorney
Doctoral Degree
20,727 satisfied customers
I am the beneficiary of a life insurance policy and the
I am the beneficiary of a life insurance policy and the insurance company won't make the check out to me.they keep sending it to the estate of Don Sergott so the bank won't cash it. I called them and … read more
LawGuy
LawGuy
Juris Doctor
123 satisfied customers
I had a life Insurance policy with All State insurance taken
i had a life Insurance policy with All State insurance taken out in 1997 for 25.000 whole life. I then increased it to 60.000 paying regularly each mos. I was told they had turned it over to Universal… read more
Olivia Kent
Olivia Kent
Managing Partner
Doctoral Degree
1,959 satisfied customers
We applied for adult child with disabilities benefits for
We applied for adult child with disabilities benefits for our son. After being denied under reconsideration with began working with an attorney. Over the last year or so we have met with her once and … read more
Ray
Ray
Lawyer
Doctoral Degree
30,843 satisfied customers
We just received a copy of the insurance policy the cover
We just received a copy of the insurance policy the cover letter says that it doesn't provide any coverage for automobile accidents. I've attached it please let me know what you think thank you… read more
Michael Bradley
Michael Bradley
JD
1,191 satisfied customers
My mother has a insurance policy that matured in 2007 and
my mother has a insurance policy that matured in 2007 and cant ins. to tell us anything what should we do. … read more
Barrister
Barrister
Attorney/Landlord/Realtor
Doctoral Degree
35,316 satisfied customers
I am planning on buy in a separate insurance policy with a
I am planning on buy in a separate insurance policy with a different company for my teen driver and myself with specific vehicles. Can my current insurance company legally raise my rates on vehicles t… read more
INFOLAWYER
INFOLAWYER
Attorney
Doctoral Degree
20,727 satisfied customers
I bought an insurance policy and one of the statements in
Hello, I bought an insurance policy and one of the statements in the policy make me think the policy is not valid. "This policy is written by an unauthorized insurer and is not subject to the filing o… read more
INFOLAWYER
INFOLAWYER
Attorney
Doctoral Degree
20,727 satisfied customers
If a beneficiary to an insurance policy dies, do the
If a beneficiary to an insurance policy dies, do the proceeds get distributed according to that beneficiary's will or are they distributed according to the Insurance policy such as divided equally amo… read more
Michael Bradley
Michael Bradley
JD
1,191 satisfied customers
My disability insurance company does not want to pay what I
My disability insurance company does not want to pay what I deserve. They calculated my SSA award and made up an amount for my Teacher's Retirement due to Disability which is well above what I will re… read more
Law Educator, Esq.
Law Educator, Esq.
Attorney
Doctoral Degree
42,358 satisfied customers

DISCLAIMER: Answers from Experts on JustAnswer are not substitutes for the advice of an attorney. JustAnswer is a public forum and questions and responses are not private or confidential or protected by the attorney-client privilege. The Expert above is not your attorney, and the response above is not legal advice. You should not read this response to propose specific action or address specific circumstances, but only to give you a sense of general principles of law that might affect the situation you describe. Application of these general principles to particular circumstances must be done by a lawyer who has spoken with you in confidence, learned all relevant information, and explored various options. Before acting on these general principles, you should hire a lawyer licensed to practice law in the jurisdiction to which your question pertains.

The responses above are from individual Experts, not JustAnswer. The site and services are provided “as is”. To view the verified credential of an Expert, click on the “Verified” symbol in the Expert’s profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).

DISCLAIMER: Answers from Experts on JustAnswer are not substitutes for the advice of an attorney. JustAnswer is a public forum and questions and responses are not private or confidential or protected by the attorney-client privilege. The Expert above is not your attorney, and the response above is not legal advice. You should not read this response to propose specific action or address specific circumstances, but only to give you a sense of general principles of law that might affect the situation you describe. Application of these general principles to particular circumstances must be done by a lawyer who has spoken with you in confidence, learned all relevant information, and explored various options. Before acting on these general principles, you should hire a lawyer licensed to practice law in the jurisdiction to which your question pertains.

The responses above are from individual Experts, not JustAnswer. The site and services are provided “as is”. To view the verified credential of an Expert, click on the “Verified” symbol in the Expert’s profile. This site is not for emergency questions which should be directed immediately by telephone or in-person to qualified professionals. Please carefully read the Terms of Service (last updated February 8, 2012).

Show MoreShow Less

Ask Your Question

x