Legal Question in Insurance Law in California

I have a private insurance company that I have been paying into since 2005 in case I were to become injured and not be able to work. I injured my shoulder on November 3, 2009 and it caused me a lot of pain. However, I continued working because I needed to get enough hours in at work to be able to retire. Since it was NOT considered a workers comp case, I could not take off work for long enough to recover with my job held, so I decided to tough it out until I could retire. The doctor diagnosed me on 11/23/2009, and I went out on disability on 9/13/2010, and retired 10/1/2010. I had surgery to fix the problem which I am still recovering from after my retirement date.

Here's the problem. My private insurance company denied me because their policy states you have to stop working 180 days after the injury date to qualify for a payment. The reason I didn't do this is because my retirement income would have been decreased for life due to me retiring early. If I was never injured, I could have continued working and increased my monthly income by earning more hours into retirement. I'm wondering if there is any way to appeal this 180 policy. I have 60 days from the receipt of the denial letter to appeal it, and I was hoping this could fall under some sort of extenuating circumstances.


Asked on 2/08/11, 5:35 pm

1 Answer from Attorneys

It would be a matter of interpretation of the policy, which we cannot do here. I have to tell you, though, it is unlikely. The disability policy is to cover lost income. You didn't lose income if you kept working. So there would be nothing to cover even if they waived the 180-day requirment.

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Answered on 2/08/11, 5:49 pm


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