On July 27, 2016, the U.S. Court of Appeals for the Seventh Circuit handed down a decision in the case of Berg v. New York Life Ins. Co. reversing an adverse judgment in the district court against DeBofsky, Sherman & Casciari’ client, Eric Berg. The court of appeals found in Berg’s favor on two significant issues: First, the court ruled that a claimant for disability benefits did not have to be under a doctor’s care for the claimed disabling condition as of the date the claim arose. The court found the policy lacked such a temporal requirement and that its terminology was ambiguous on the issue. Second, the court found that if the insured is unemployed when he submits a claim, his “regular job” is the occupation that was last performed, not the so-called occupation of “unemployed person.”
This ruling is significant on both issues and will no doubt be cited frequently in future litigation involving disability benefits. Furthermore, yet again, it highlights the importance of retaining an experienced disability benefits attorney when your claim has been denied and you feel cheated. The insurance companies employ a battalion of lawyers to minimize the money they have to pay for claims. Similarly, as an injured or disabled person, you need an attorney on your side to protect your interests.