Working with Disability Claim Managers
– Know Your Rights and Be Vigilant
Even though disability insurance companies have a duty under Arizona law to give your interests equal consideration to their own, insurers rarely act for the policyholder’s benefit. Claims benefit managers are frequently taught how to approach disability claimants to get a desired result, usually a denial or termination of disability benefits. From our years of experience with the disability insurance industry, we have learned some of the tactics claims personnel use. The following is a list of strategies to beware of. Though not every disability claim manager engages in these practices, it is always a good idea for claimants to be vigilant in order to protect their rights under their policy.
- Treating claims like a unit of production. Disability insurance companies often don’t care to know how being disabled and filing for benefits affects you personally. Don’t expect that they will understand or be sympathetic to the personal toll the entire process takes on a claimant, especially a doctor or dentist who has spent years in study and practice to achieve professional success. To disability insurers, each claim is a unit of production being channeled towards an end goal.
- Misinterpreting policy provisions. Disability insurance claims managers are not lawyers, and just like most people, often have trouble properly interpreting complicated insurance policies. For example, claims personnel might inform an insured that her claim is an “any occupation” policy when in fact it is an “own occupation” policy.
- Claiming rights that don’t exist under the policy. Claims managers will also frequently indicate that the disability insurance company can make claimants do certain things or provide certain information that is not actually required under the individual policy. For instance, an insurer might tell a claimant he needs to complete a detailed daily activity report, when there is actually no such requirement to do so in his policy. Make sure you know what your policy does and does not actually allow.
- Acting like your friend. Employees of disability insurance companies often try to act like your friend or partner in the process, when they are actually channeling your disability claim towards denial or termination of benefits. Often, claims managers will call an insured for a friendly chat, all the while peppering the insured with seemingly innocuous questions meant to provide evidence for claim denial. Policyholders should understand the questions being asked, and not get distracted by the congeniality of the caller.
- Sending “field investigators” to talk about your claim. Another common practice in the disability insurance industry is to schedule an in-person interview in the claimant’s home with a “field investigator.” These interviewers will spend hours asking about your symptoms and activities in excruciating detail, taking copious notes and even asking to photograph you. What they may not make clear is that the field investigator has no authority over the disposition of your claim. Rather, he or she is a private investigator hired by your insurance company to gather evidence against your claim and provide a starting point for surveillance.
The best way to make sure that these claims management practices aren’t used to take advantage of you when making a claim for disability benefits is to enlist a disability insurance attorney who knows the tactics used and how to guard against them. Nevertheless, every insured should understand their insurance company’s approach to claims management and be cautious in their interactions with claims management personnel.
