Insurance Company Tricks and Tactics: What You Need To Know

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 long-term disability 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 claims adjusters are trained to delay and deny claims if they can.

Here are some tactics long term disability companies use to trick you or otherwise try to avoid paying out benefits:

Prolonging Your Claim Process

  1. Requesting additional and/or irrelevant documents. One of the ways the insurance company will try to delay paying your benefits is to request duplicate copies of 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.
  2. 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 when you need them to.

Requiring Multiple Independent Medical Examinations

Another tactic is sending you for multiple Independent Medical Exams (IME). Your long term disability insurance company 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. We have an entire article all about IME’s and how to protect yourself here: The Independent Medical Examination in Long Term Disability Cases.

Twisting Your Job Description

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.

Video Surveillance

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. Read our article about protecting yourself while under surveillance here: Video Surveillance and Long Term Disability Insurance Claims.

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.

Many questions need answers when you are dealing with disability benefits and insurance companies. If you are not getting the answers you need, give us a call at (888) 321-8131.

Although based in Florida, the Ortiz Law Firm is a national disability insurance law firm and represents claimants across the United States. If you’d like to speak to one of our experienced Long-Term Disability Insurance Attorneys contact us at (888) 321-8131 to schedule a consultation. We can help you evaluate your claim to determine whether you qualify for long-term disability benefits and how to navigate through the appeals process if your claim has been wrongfully denied or terminated.


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