CPA Disability Claims

Navigating a long-term disability claim can be one of the most challenging periods in a Certified Public Accountant's (CPA) career. For accounting professionals, the nature of their work, demanding cognitive abilities, meticulous attention to detail, and adherence to strict deadlines, means that even seemingly minor health issues can significantly impact their capacity to perform their duties.

At Sandstone Law Group, we understand the unique pressures faced by CPAs and are dedicated to ensuring their long-term disability (LTD) claims are handled with the aggressive advocacy they deserve.

The Unique Nature of CPA Disability

Many disability insurance companies often misunderstand the true nature of an accountant's job. They may mistakenly classify it as "sedentary," suggesting that if a CPA can sit at a desk, they can work. This overlooks the demanding cognitive and analytical skills, the precision, and the significant stress involved in an accountant's daily responsibilities.

The reality is that accounting involves:

• Intense Cognitive Demands: Hours spent analyzing complex financial data, preparing intricate reports, and making critical calculations.
• Client Interaction and Deadlines: Routine meetings with clients, strict deadlines, and the pressure of avoiding costly errors.
• Travel and Physical Aspects: While often perceived as sedentary, many accountants travel to client offices, requiring physical mobility.

Conditions that impair cognitive abilities, concentration, memory, or cause chronic pain can be profoundly disabling for a CPA, even if they appear "minor" to an uninformed insurer. Conditions such as carpal tunnel, arthritis, persistent eyestrain, migraines, depression, anxiety, insomnia, or even mental fatigue can significantly hinder a CPA's ability to perform their job effectively.

We have seen insurers claim:

• You are "not disabled" because you can do some administrative work, even if you can no longer perform complex audits, prepare tax returns, or advise clients.
• Your neurological, stress-related, or pain-based condition is "subjective" or "self-reported," and therefore excluded or minimized.
• Your loss of income does not qualify as total disability, even after a dramatic drop in clients, billable hours, or project load.

These are not good-faith misunderstandings. These are deliberate strategies used to avoid paying valid claims.

Understanding CPA Disability Insurance Coverage

CPAs typically obtain disability insurance through several different channels, each with distinct characteristics and legal protections:

• Private Individual Disability Insurance (IDI): Many CPAs purchase individual disability income policies directly from insurers like Guardian, Berkshire, Principal, MetLife, or other carriers. IDI polices are not governed by ERISA and may provide stronger legal protections, including the right to jury trial and potential punitive damages under state insurance bad faith laws.
• Employer-Sponsored Group Plans: CPAs working for accounting firms or corporations may have group long-term disability coverage through their employer. Most employer-sponsored LTD plans fall under the Employee Retirement Income Security Act (ERISA), which creates a restrictive legal framework that heavily favors insurers.
• Professional Association Coverage: Some CPAs may obtain coverage through professional associations or other group arrangements that may or may not fall under ERISA, depending on the specific structure and sponsorship of the plan.

ERISA's Impact on Group Disability Claims

When your disability coverage is governed by ERISA, you face significant legal limitations that make challenging wrongful denials extremely difficult:

• You cannot seek punitive damages, even if the denial was malicious or outrageous.
• You have no right to a jury trial.
• The court typically cannot consider any new evidence beyond what was submitted during the insurer's internal review process or otherwise a part of the "administrative record."
• The only remedy is often being put back on claim with the insurer or, worse, simply a remand back to the insurance company for further claims handling.
• Future benefits do not vest, so a court cannot award them.

In short, ERISA strips claimants of many legal protections that would otherwise be available in a non-ERISA insurance dispute. Insurance companies know this and take advantage of it. Under ERISA, the risks of denying valid claims are low, while the rewards of delay or refusal are high.

The Nuances of Proving Income Loss for CPAs

For CPAs, proving the extent of income loss due to a disability is rarely straightforward, particularly when dealing with the rigorous scrutiny of insurance companies. Unlike a fixed-salaried employee, a CPA's income can be highly variable and multifaceted, presenting unique challenges when a disability affects their earning capacity.

Variability in CPA Income Structures:

• Partners and Firm Owners: Income often includes salary, draws, profit distributions (K-1s), and bonuses. A disability might not immediately eliminate all "income" if the firm continues to generate revenue, even if the CPA can no longer contribute actively.
• Self-Employed CPAs: Individual practitioners face challenges in distinguishing between business expenses and personal income, and proving the direct impact of their disability on client acquisition, retention, and billable hours.
• Commission or Bonus-Based Income: CPAs with significant commissions, performance bonuses, or revenue-sharing agreements face additional complexity in establishing pre-disability income baselines.

Insurance companies often demand extensive financial documentation and may scrutinize every detail to find reasons to deny or underpay claims, including tax returns, profit and loss statements, payroll records, billing records, client lists, and partnership agreements.

CPA Disabling Conditions

Common disabling conditions that impact accountants include:

• Musculoskeletal and Orthopedic Conditions: Cervical and lumbar disc herniations, carpal tunnel syndrome, arthritis in hands and wrists, and chronic low back pain from prolonged sitting and repetitive work.
• Neurological and Cognitive Disorders: Multiple sclerosis, Parkinson's disease, post-concussive syndrome, long COVID-related complications, migraines, and early-onset dementias that impair analytical thinking and accuracy.
• Mental Health Conditions: Major depressive disorder, anxiety disorders, panic disorder, and burnout from high-pressure, deadline-driven environments.
• Medication Side Effects: Treatment-related impairments like drowsiness, cognitive dulling, or delayed reflexes that compromise professional performance.

Common Challenges in CPA Disability Claims

Regardless of whether your coverage is through AICPA, an individual policy, or an employer-sponsored plan, CPAs often encounter specific issues when filing LTD claims:

• Mischaracterization of Occupation: Insurers may attempt to downplay the complexity of an accountant's job, classifying it as a simple "sedentary" role to argue that you can still work.
• Insufficient Medical Evidence: Even with a clear diagnosis, if your medical records do not adequately detail your functional limitations and how they impact your specific duties as a CPA, your claim may be denied. Insurers look for objective findings and consistent treatment.
• Cognitive Impairment Underestimated: Cognitive difficulties (e.g., issues with concentration, memory, problem-solving) are a frequent cause of disability for accountants but are often harder for insurers to objectively assess.
• "Any Occupation" Shift: Many policies transition from "own occupation" to "any occupation" definitions after a certain period, making continued benefits significantly more difficult to obtain.

AICPA Disability Insurance Claims

The American Institute of CPAs (AICPA) provides a group long-term disability insurance plan, primarily underwritten by Prudential, available to its members. AICPA plans are generally not governed by ERISA because they are association plans offered through the AICPA Insurance Trust, not employer-sponsored plans. This distinction is important because it means AICPA disability claimants may have access to stronger legal protections than those with typical employer-sponsored ERISA plans.

However, the absence of ERISA governance does not mean AICPA claims are automatically easier to pursue. Insurance companies still employ aggressive tactics to deny or minimize legitimate claims, and the complex nature of association-sponsored coverage can create unique challenges in pursuing benefits. Consulting with experienced ERISA lawyers can help policyholders better navigate these complexities and improve their chances of a successful outcome.

AICPA Claim Considerations

If you have disability coverage through the AICPA, several factors may impact your claim:

• Policy Terms: AICPA policies typically offer "own occupation" coverage, but some policies may transition to an "any occupation" definition after a certain period (e.g., 24 months), making it significantly harder to continue receiving benefits.
• Underwriting Practices: Since Prudential underwrites most AICPA plans, claimants often face the same aggressive claim handling practices associated with this major insurer.
• Documentation Requirements: Like all disability claims, AICPA claims require comprehensive medical and occupational evidence to establish the extent of functional limitations and their impact on your specific duties as a CPA.

Why Sandstone Law Group?

You deserve a law firm that understands the value of your career, the weight of your responsibilities, and the legal leverage it takes to make insurers deliver on their promises.

At Sandstone Law Group:

• We Understand CPAs: At Sandstone Law Group, we understand the unique cognitive and physical demands of being a CPA, and how even subtle impairments can threaten your ability to practice safely. Whether your policy is with Guardian, Berkshire, Principal, or another major carrier, we know how to align real-world accounting duties with the language of your disability contract.
• We Listen First: From your time speaking with our attorneys, Kyle and Erin, we take the time to understand your daily responsibilities as a CPA and your policy. You will not be rushed or handed a generic plan. We know your case is personal, and we approach it with the same care and precision you have given your clients.
• We Know the Insurer’s Playbook: We have gone head-to-head with nearly every major disability insurer in the country, including MetLife, Guardian, Unum, The Standard, and Prudential. We know their tactics and we know how to dismantle them.
• We Are Prepared for Litigation: Unlike firms that solely concentrate on ERISA group plans, we focus heavily on IDI litigation. We know how to use bad faith laws to pursue punitive damages, emotional distress compensation, and full discovery, because private policies give us room to fight hard.
• We Win for Accounting Professionals Like You: Our firm has recovered millions in long-term disability benefits and legal damages for professionals. Whether your policy promises “own-occupation” protection or includes layered coverage for partial or residual disability, we hold insurers accountable to the letter of the contract.
• We Treat Clients Like Partners: You are a high-level professional. We treat you like one. That means proactive communication, transparent strategy, and a legal relationship built on mutual respect. When you hire us, you are gaining a dedicated team.

Has Your Disability Claim Been Denied?

If you are a CPA and your long-term disability claim—whether through AICPA, an individual policy, or employer-sponsored coverage—is being stalled, denied, or underpaid, you do not have to face these challenges alone.

At Sandstone Law Group, we recognize the complex legal landscape surrounding CPA disability claims and are prepared to build comprehensive cases that pressure insurers to honor their obligations. We fight to ensure insurers understand precisely what your specialized job requires and why your claim is valid.

Contact Sandstone Law Group at (602) 615-0050 to schedule a confidential consultation.