Wrongly Denied Disability Can Affect Anyone

Gravenhurst, ONThere is a certain stereotype when it comes to wrongly denied disability claims: individuals who are injured on the job requiring medical attention and rehabilitation, service personnel returning from battle in need of treatment and / or disability due to the inability to function due to, say, post traumatic stress disorder. However, wrongly denied disability comes in all shapes and sizes, as we shall see.

In Canada, a single mother working two jobs to make ends meet has been turned down for a government grant to repair mushrooming mould in her mobile home. The program, founded and maintained in an effort to allow homeowners to stay in their homes longer through the eradication of structural problems and other issues that could threaten a homeowner's health and safety, includes mobile homes and trailers used as residences on a case-by-case basis.

However, Nicole Bowser of Gravenhurst, a picturesque town located in north central Ontario, has learned her residence doesn't qualify because it's located in a trailer park. Because Bowser does not own the land her home sits on, her application won't even be considered—even though she owns the dwelling and holds a mortgage on it.

According to the Bracebridge Examiner (10/17/12) the family is sick with mould. While she's doing the best she can on her own, with limited time and resources her options are few. Bowser feels the program administrators are acting in bad faith.

Meanwhile, the Boston Herald reports that a judge has found himself on the denial end of disability benefits. In many instances, it is the judge that determines who is, and isn't awarded disability payments.

According to the Herald (9/1/12), former Superior Court Judge Ernest B. Murphy had been presiding over a case in 2002 when a note containing a death threat was slipped under the door to his chambers.

Murphy carried on until 2007 when, according to reports, he abruptly stepped down from the bench and filed for a disability pension the following year. The Herald reports that Murphy cited "emotional conditions, including anxiety, depression, panic disorder and posttraumatic stress disorder," in his application.

The applicant was denied by the Contributory Retirement Appeal Board, which ruled they had no way of knowing whether, or not Murphy was actually performing work of the Court when he was closeted within his chambers at the time the death threat was delivered.

Murphy appealed his wrongly denied disability claim. However the Supreme Judicial Court upheld the earlier decision in a unanimous finding that pertained to a burden of proof, or lack thereof, that Murphy was performing work behind closed doors in his chambers.

One might assume that a judge, closeted within his chambers, is performing work on behalf of the court. However, both the Contributory Retirement Board and the Supreme Judicial Court held that the notion of Murphy performing work in his chambers was only an assumption at best, and that the applicant "failed to satisfy his burden of proving that the personal injury that resulted in his permanent disability was sustained while he was performing his judicial duties."

The Supreme Court had this to say:

"Assuming that Judge Murphy read this death threat in his chambers, there was no evidence whatso-ever (sic) as to what he was doing when he opened and read it," the court wrote, citing case law that says the court should not assume employees who are in their offices are working. "The employee certainly may be so engaged, but that is not a foregone conclusion. Rather, it is a fact that must be proven by the applicant for benefits," the Court wrote.

While the foregoing are two unique cases, what is not unique is the tendency for insurance companies to balk at the payment of disability claims—even in legitimate cases—in spite of the policyholder diligently paying premiums for years in order to maintain a policy in good standing.

While there are those who will try to pull the wool over an insurer's eyes, the vast majority of claimants are honest, hard-working Americans who have become sick or injured through no fault of their own, and simply seek the benefits which are their due according to the tenets of their policy.

A good faith insurer delivers the goods as contractually and morally obligated according to a paid-up policy in good standing, properly and carefully kept current by the policyholder.

A bad faith insurer accepts year's worth of premiums, only to cry foul when it comes time to pay up.