Arlington lawyers need to have understanding of disability insurance policies to properly advise a prospective client.
Regarding the commencement of coverage, disability policies normally require that any claimed disability occur while the policy is in effect or within a specified time after the claimed accident or injury. Here is an example. A policy may provide coverage for an illness or injury that “totally and continuously disables the insured within 30 days of the date of the accident so as to prevent him or her from performing each and every duty pertaining to his or her occupation.”
Most disability insurance policies will distinguish between disabilities caused by illness and those resulting from accidental injury. The Beaumont Court of Appeals issued an opinion in 1978, in the case Lone Star Life Insurance Company v. Griffin, wherein a policy provided that the insurance company would pay the insured $1,000 per month for 60 months for an accidental injury resulting in total disability and that it would pay $1,000 per month for 24 months for total disability resulting from sickness.
As in the example above, a shorter period of benefits is usually provided for disability based on sickness, while longer benefits are payable for disabilities resulting from accidental injury. It is noteworthy that the reason for this distinction is that far fewer disabilities result from accidents than from illness, so greater benefits can be provided.
The Texas Administrative Code includes provisions relating to disability insurance as promulgated the Texas Department of Insurance. Texas Administration Code, Section 3.3040(e) tells us the a disability policy may not provide for reduction of disability benefits if the insured is not employed away from his or her place of residence.
Section 3.3059 tells us that a disability policy may contain provisions relating to recurrent disability, but such a provision may not specify that the disabilities be separated by a period greater than six months.
An experienced Insurance Law Attorney learns pretty fast that laws regulating insurance can be found in many places. The obvious places for an attorney are case law and the Texas Insurance Code. Most attorneys will not think about the Texas Administrative Code nor will they realize some of the resources available from the Texas Department of Insurance.
Updated: