Private self-paid long-term disability

[BamBamForni]

What is the name of your state (only U.S. law)? Illinois
I have a disability policy which pays benefits if I cannot perform the major duties of my specific occupation. Due to arthritis and degenerative disc disease, it is too painful to do my job anymore. I will occasionally take pain pills to give me relief from my pain. However, I refuse to take them daily, because of the potential side effects synthetic, prescription medication can do to the body over long-term use. Can my private disability company legally deny me benefits because I would rather endure my pain, than take the pills everyday?

 

[cbg]

Without reading the exact terms of your plan document, we can't say.

 

[BamBamForni]

There are three conditions in my contract to satisfy total disability:
1. I cannot perform 80% of the major duties of my occupation.
2. I am not gainfully employed in any other occupation.
3. I am under the care of a physician. This is waived if there is proof no further treatment is helpful.

I was told by everyone I spoke with at the insurance company, that they cannot force me to take pills.
However, I now wonder, if that is true, it may not mean they cannot deny if I don't take pills.
They may feel if the pills could help me, I should take them everyday. I feel, how can taking prescription pills every day help me if, over long term use, I end up with liver or kidney disease.

 

[cbg]

Okay, once again.

ONLY someone who has read YOUR ENTIRE policy can say what they are and are not required to pay for and under what circumstances. It is not enough to list the eligibility requirements; there could be language elsewhere in the policy that qualifies it.

If you are not happy with the answers the insurance carrier is giving you, and I understand why you are not, you'll need to show the ENTIRE policy to a local attorney, preferably one versed in benefit law.