The lawyers in our firm are focused on helping people with disability policies and ERISA claims. Today, we want to help you understand what the term “entire contract” or “legal contract” means in your disability policy.
Most people think that the policy itself is the entire contract, but that is rarely the case. Most policies will have a provision that defines what the entire contract is. It reads something like this:
The policy with the application and attached papers is the entire contract between you and us.
This is very important because every document that is part of the overall agreement binds both parties, rarely is it just the policy itself. The entire contract often includes the application, a writer, a certificate, and any amendments. You must have all of these documents to understand your rights.
If you obtain the policy through your employer, there will likely be a contract between the employer and the insurance company, and there will also be a certificate of insurance and summary plan description. Only the certificate and/or summary plan description are provided to you. Courts have said that a summary plan description is not a binding document. And often the certificate may say that the policy controls.
To know your rights, you have to know all of these key terms. It is important to realize that anything that is told to you that is in conflict with the policy may not be binding. Not on the insurance agent or the insurance company. If you only have a part, it is like only having part of the rulebook in the game of football. It is crucial to know all the rules before you engage in any sort of contest, rather than to learn them after it is too late.
Remember our ERISA attorneys and long-term disability lawyers are here to help if you run into problems. Contact us at the first sign of trouble with your disability claim.