Loss of Work Capacity Lawsuits

Did you fall from a ladder during work and injure your back? Did you slip at your workplace and break your arm? This is precisely why disability insurance exists, designed to protect us from the dangers involved in the event of losing the ability to work fully or partially as a result of an accident or illness. Therefore, the importance of this insurance cannot be overstated when it comes to our source of livelihood upon which our children and loved ones depend.

Disability insurance policies can be divided into two main types:

Insurance policy for total disability according to the insured's specific occupation – a situation where you are injured and are completely unable to work in the profession you were engaged in during the period preceding the accident or illness at a rate of at least 75%.

Work insurance policy for total disability not according to the insured's specific occupation – a situation where you are injured and are completely unable to work in the profession you were engaged in during the period preceding the accident or illness at a rate of at least 75%, and you also cannot work in any other reasonable occupation, according to your education, training, and experience.

There are insurance policies for disability that also include insurance for partial disability (starting from 25%), whereby if you are injured in a manner that allows you to work only partially, then you will be entitled to payment of insurance benefits according to your partial work capacity.

Disability benefits will be paid to you by the insurance company as long as you are in a state of disability as defined in the disability insurance policy, provided that you are not working and the insurance period has not expired.

There are three main reasons for rejection of a claim by the insurance company:

The conditions of the insured event are not met – the insurance company believes that you are not in a state of disability as determined in the policy. For example, you do not meet the requirements of the degree of disability, or you are able to engage in other reasonable occupations besides your profession that suit your experience, training, and education.

Non-disclosure and concealment of details – a very common reason. In practice, the insurance company claims that at the time of joining the insurance you violated the duty of disclosure and concealed from it details and medical information that would have changed its position regarding the insurance. That is, it is possible that if it had known all the details, it would have charged you higher insurance premiums, excluded certain situations from the policy content, or not insured you at all.

Exclusion from insurance coverage – a condition that appears in the insurance policy and which negates the insurance coverage. For example, a condition in the policy according to which an insured who loses his ability to work due to drug use or alcohol consumption is not entitled to insurance benefits.

In light of the existence of complex conditions in disability insurance policies that raise many difficulties, and in light of the many rejections of disability insurance claims by insurance companies which often have no justification whatsoever, if you have a disability insurance policy and have lost the ability to work, we recommend that you contact our office for legal consultation and examination of your legal situation.