Your long term disability insurance is intended to be there to protect you in case you become disabled due to an injury or illness. You pay your premium so when you need to file a claim, you shouldn’t have a problem. However, the insurance companies do not make money by paying out claims. They make money by managing risk – hoping that from a large pool of employees, only a few will file claims. The few who do need to file claims will find it difficult because the insurance claim adjusters are trained to delay and deny claims if they can.
Here are some tricks and tactics that disability insurance carriers use to avoid paying out benefits:
Prolonging Your Claim Process
- Requesting additional and/or irrelevant documents. These are documents that you either already provided or extra documents that are not necessary to decide your claim. An example might be requesting your medical records from decades ago, even if that has nothing to do with your current injury or illness. They may try to use these to prove that you had a pre-existing condition to deny your claim.
- Changing your claims adjuster. The insurance company may assign a new claims adjuster to your case. The new claims adjuster will want time to review your claim, causing a delay in a decision. Also, when your adjuster is out sick or only works part-time, they will not be able to assist you if you need them to.
Requiring Multiple Independent Medical Examinations
Another tactic is sending you for multiple Independent Medical Exams (IME). Your insurer has the right to request that you submit to an independent medical exam as part of the claims process. This examiner is hired by the insurance company to put you through rigorous tests to determine if you really are disabled. They will look for any sign that you are not being truthful and use that to deny your claim. If the IME examiner agrees with your doctor that you are in fact disabled, the insurance company can send you for another IME. And another. And another. There have been cases of claimants going through 5 or more IMEs before their attorney could put a stop to it.
Twisting Your Job Description
In your application for long term disability benefits, you will need to state your job position. This forms the basis for evaluating whether your disability prevents you from performing that job. However, the insurance company will not just take your word for it. The insurance company will request a job description from your human resources department or employer. Your employer will then provide the insurance company with a detailed job description.
This job description is critical to the evaluation of your disability claim because the insurance company is evaluating your medical records to determine whether you can perform the duties of your job. The insurance company may try to twist your job description to make it appear that you can still work. They may highlight simple daily tasks and make them appear that these are your primary duties and responsibilities.
Because the job description is critical, you must request a copy of whatever your employer provided to the insurance company so you can make sure that the job description accurately describes what you actually did on a day-to-day basis when you were working. In other words, you may have performed your job a little differently than it is described on paper. These differences between your job “as described” and “as performed” may make the difference in whether you win or lose your claim. For these reasons, it is very important that you obtain a copy of the job description to ensure it accurately describes your job “as performed” by you.
Video surveillance is used by the insurance company often. The insurance company will hire an investigator to sit outside your home and videotape you. It is perfectly legal to do this, and they can use the tape in court. The best way to protect yourself is to stay vigilant about who is parked outside your home. They will even go and talk to your neighbors to find out about your daily activities. Anything can be taken out of context. They could use a tape of you letting your dog outside to prove you can walk without a cane. It’s outrageous but legal.
Wrongful Termination of Benefits
When you submit your claim, you may be approved right away and think “well, that wasn’t so bad!” Do not be fooled by fast approval. Many insurance companies will require you to submit ongoing paperwork to prove your disability. This could be updated medical reports verifying that you have kept your doctor’s appointments, and verifying that you have been getting your prescriptions filled as prescribed. If you do not send in the evidence, you may experience a wrongful termination of benefits.
Tricky Phone Interviews
The claims adjuster will likely call you and set up a phone interview to review your claim. During this interview, they will try to make the conversation seem casual. They may try to ask you tricky questions to keep you talking, hoping that you will admit to something they can use against you later. Do not be fooled. This is not a conversation with a friend. The job of the claims adjuster is to deny your claim to save the company money.
When dealing with the insurance company, remember that they are a for-profit business. They will try to use whatever loophole and tricky tactics they can to deny your claim. The goal is to prolong your claim so that the benefits payout to you is as small as possible. You may even get frustrated and tired of waiting and give up, which is even better for them. This is why hiring an experienced professional disability attorney is so important. Let your attorney deal with the tricks and tactics used by the insurance company.
The Ortiz Law Firm is based in Florida, but represents claimants anywhere in the United States. We will determine the best strategy to defend your claim and help you navigate through the appeals process. If you want to talk to an experienced Long-Term Disability Attorney about your case, call us at (888) 321-8131 to schedule a free case evaluation.