Mark DeBofsky Reveals Hidden Disability Insurance Risks on Income Protection Journal Podcast

Listen to the Full Episode

Many high-income professionals purchase disability insurance coverage believing it will automatically protect them if they become unable to work. Years later, they discover the fine print determines whether benefits get paid, reduced, or denied outright.

ERISA disability insurance attorney Mark DeBofsky shared these insights during a recent appearance on the Income Protection Journal Podcast, hosted by Jamie Fleischner, CLU, ChFC, LUTCF, founder of Set for Life Insurance and a nationally recognized disability insurance advisor to physicians and other high-earning professionals.

During the wide-ranging discussion, Mark DeBofsky addressed common misconceptions about disability insurance, the claims process, and why policyholders frequently underestimate the importance of policy language until it is too late.

“The most important feature to look for in an individual disability insurance policy is own-occupation coverage,” DeBofsky said. “Even a small degree of impairment can be total devastation to the ability to continue in that occupation, and you want to have it as fine-tuned as possible.”

When “Own Occupation” Does Not Mean What Policyholders Think

DeBofsky cautioned that policies marketed as “own occupation” may still contain provisions insurers later use to limit or deny benefits. Understanding the meaning of “regular occupation” in a disability insurance policy is essential before filing a claim.

“A true own-occupation policy will pay benefits if you cannot perform your occupation but are working in a different occupation, even if you are earning more than before,” he said. “But many policies quietly redefine disability once you start earning income elsewhere.”

He described a pending federal appeals case involving a dentist whose policy appeared to offer own-occupation protection but allowed the insurer to deny benefits based on a vague definition of “gainful occupation.”

“The insurance company made up its own standard,” DeBofsky said, explaining that the insurer argued any job paying above the state’s median wage disqualified the claimant, regardless of the insured’s profession, education, or prior earnings.

“Choosing the lowest quote is usually the wrong decision,” he added.

Group Coverage Versus Individual Coverage

DeBofsky also drew clear distinctions between employer-provided long-term disability insurance and individual disability insurance policies, differences he said many professionals fail to understand.

“Conceptually, they are different products,” DeBofsky said. “An individual disability policy protects your ability to earn an income in your profession. A group policy protects a percentage of your salary at the time of disability, and often only temporarily.”

Most group policies are not true own-occupation policies or limit own-occupation coverage to a short period, typically 24 months. After that, claimants may be required to prove they cannot work in any occupation. This changed definition can halt disability benefits unexpectedly.

Group policies also typically reduce benefits by Social Security Disability payments and may result in taxable income, depending on who paid the premiums.

“The benefits people think they have are often worth far less than they assume,” DeBofsky said.

What Happens After a Claim Is Filed

On the podcast, DeBofsky walked listeners through what to expect when filing a disability insurance claim. While many claims are approved, insurers closely scrutinize medical records and often seek objective evidence beyond a physician’s certification.

Certain conditions, he said, are more likely to be challenged. Understanding what constitutes objective medical evidence of disability is critical for claimants.

“There is no test for long COVID,” DeBofsky said. “It does not show up on an MRI or a blood test. Fatigue, dizziness, and brain fog are real, but they are difficult for insurers to measure.”

He said similar challenges arise with chronic fatigue syndrome and fibromyalgia, migraines, and some early-stage neurological diseases.

Why Some Claimants Should Consult a Lawyer Before Filing

One of DeBofsky’s strongest messages was that legal guidance can be valuable before a claim is filed, not just after a denial. Knowing when to hire a disability benefits attorney can make a significant difference in outcomes.

“We recommend that someone even contemplating a claim speak with us before submitting it,” he said. “That allows us to head off problems before they become expensive and irreversible.”

For group disability claims governed by ERISA, he warned that strict deadlines apply.

“Claimants have 180 days from receipt of a denial to file an appeal,” DeBofsky said. “And once that appeal is complete, courts generally will not allow new evidence. If the record is not built correctly, it cannot be fixed later.”

Understanding the importance of ERISA claim appeals is essential for anyone facing a denial of benefits.

Mental Health Limitations and the “Discount” Policyholders Regret

DeBofsky also criticized benefit limits on mental health conditions, which he said are increasingly common in both group and individual policies.

“Almost all group policies, and a growing number of individual policies, cap mental health benefits at 24 months,” he said. “People are often offered a discount to accept that limitation, and they should not.”

“No one expects to become disabled, and no one knows what condition will cause it,” DeBofsky added. “You do not want to give the insurance company an escape hatch.”

Surveillance, Social Media, and Context

Addressing common fears, DeBofsky said private surveillance and social media investigations are far less common than many claimants assume and rarely prove decisive. Social media, however, can be misinterpreted.

“We encourage clients to be thoughtful about what they post,” he said. “Not because they are doing anything wrong, but because context can be lost.”

A Conversation Aimed at Professionals Who May Need Help Later

Fleischner, whose podcast focuses on educating high-earning professionals rather than industry insiders, framed the conversation around real-world risks and long-term planning.

Near the end of the episode, DeBofsky shared what many former clients tell him after their claims are resolved.

“They resented paying premiums for years,” he said. “Then they realized their broker gave them some of the best advice of their lives.”

Get Help With Your Disability Insurance Claim

If you are considering filing a disability insurance claim or have already received a denial, consulting with an experienced ERISA attorney can help you understand your options and protect your rights. DeBofsky Law has decades of experience representing professionals in complex disability insurance disputes.

Contact DeBofsky Law to schedule a consultation and learn how we can help with your disability insurance claim.

Listen to the full episode of the Income Protection Journal Podcast: https://setforlifeinsurance.com/income-protection-journal-podcast/

Frequently Asked Questions About Disability Insurance Claims

What is the difference between “own occupation” and “any occupation” disability insurance?

A true own-occupation policy pays benefits if you cannot perform your specific occupation, even if you are working in a different job and earning more than before. An any-occupation policy only pays if you cannot work in any job for which you are qualified by education, training, or experience. Many policies marketed as “own occupation” quietly shift to an “any occupation” definition after 24 months, which can result in unexpected benefit termination.

Should I buy individual disability insurance if I already have coverage through my employer?

Yes, in most cases. Group disability insurance through your employer typically provides weaker protection than an individual policy. Group policies usually limit own-occupation coverage to 24 months, reduce benefits by Social Security payments, and may result in taxable benefits. Individual policies protect your ability to earn income in your specific profession and offer more comprehensive, long-term coverage that stays with you if you change jobs.

Why do insurance companies deny disability claims for conditions like long COVID, fibromyalgia, or chronic fatigue?

Insurance companies often deny claims for these conditions because they lack “objective” medical evidence like abnormal MRI results or blood tests. Fatigue, brain fog, and chronic pain are real and disabling, but they are difficult for insurers to measure using traditional diagnostic tools. Claimants with these conditions should work with their doctors to document functional limitations thoroughly and may benefit from consulting an attorney before filing.

When should I hire a disability insurance lawyer?

Consider consulting a disability insurance attorney before you file your initial claim, not just after a denial. An experienced ERISA attorney can help you avoid costly mistakes, ensure your medical records properly document your limitations, and build a strong administrative record. This is especially important for group disability claims governed by ERISA, where courts generally will not allow new evidence after the appeal process is complete.

What is the 180-day ERISA appeal deadline and why does it matter?

Under ERISA regulations, claimants have only 180 days from receipt of a denial letter to file an administrative appeal. Missing this deadline can result in permanent loss of your right to benefits. Additionally, the appeal stage is typically your last opportunity to submit new medical evidence, vocational assessments, or expert opinions. If your record is not properly built during the appeal, courts reviewing your case later cannot consider evidence that was not part of the administrative record.

Should I accept a policy discount for a 24-month mental health benefit limitation?

No. Mark DeBofsky strongly advises against accepting this limitation, even at a discount. Almost all group policies and a growing number of individual policies cap mental health benefits at 24 months. No one expects to become disabled, and no one knows what condition will cause it. Accepting this limitation gives the insurance company an escape hatch that could leave you without coverage when you need it most.

Can insurance companies use social media to deny my disability claim?

Yes, but surveillance and social media monitoring are less common and less decisive than many claimants fear. However, social media posts can be taken out of context and used against you. A photo showing you smiling at a family event does not mean you can work full-time, but insurers may misrepresent it that way. Be thoughtful about what you post, not because you are doing anything wrong, but because context can easily be lost.