The Edge Series: What is “Legal Incompetence?”

The lawyers in our firm are focused on helping people with disability policies and ERISA claims. We want to give you the edge in understanding your policy. Today, we want to help you understand what the term “legal incompetence” means in your disability policy.

Many people think that being suddenly sick or hurt allows them to file their disability policy claim late. There is an exception that allows you to file a claim late. That exception is if you are not legally competent or you lack legal capacity.

Legal incompetence or legal incapacity usually refers to the inability to enter into a binding contract or to perform your duties under the contract. In the policy, this refers to how you understand things, your memory, your judgment, and the minimum skills, cognitively, that are needed to make a claim or provide proof of loss.
You are given extra time until you get better if you are legally incompetent. If you can’t comprehend basic things because you are in a coma, sedated, or suffering from brain damage, you likely lack legal competence.

This provision is important when your proof of loss is provided more than a year after it is required by the policy. However, don’t be misled. Lacking legal capacity doesn’t mean that you’re just too sick or injured to deal with it.
Just not wanting to deal with it due to being sick or in the hospital is not enough. This policy term doesn’t allow incapacitation, physical injury, or illness to alone be enough. You will have to provide a reason for late proof of loss that measures up to legal incompetence or lack of legal capacity. And that will have to be demonstrated by your doctor or an expert of some sort who can testify to that legal incompetence.

This is a very important term to remember because if you are in the hospital, you do not think of these things. Give someone durable power of attorney and tell them about your disability policy because this situation can arise for anyone.
A fall, auto accident, or illness can put you in the hospital, and if it goes on for a while, you may not think about the legal requirements in your disability policy. Let your durable power of attorney agent know about your policy and the need to file a claim, so even if you are in the hospital, someone can act on your behalf.

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.

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