Disability Insurance Claim Blog

May 2012 is Disability Insurance Awareness Month

admin — Thu, 10 May 2012 22:17:52 +0000

It is once again Disability Insurance Awareness Month, and while the insurance companies may like to celebrate by encouraging people to purchase disability insurance, we’d like to take this opportunity to repeat some information from one of our previous blog posts regarding what your disability insurer can and can’t legally do in Arizona if you file a claim.

What your disability insurance company can do

Audit your billing records and tax returns
Review your medical files
Use a private investigator to conduct photographic and video surveillance
Look at your public Facebook profile and photos
Follow your tweets on Twitter
Order an Independent Medical Exam
Have their doctor opine about your disability
Ask for a Functional Capacity Evaluation
Contact your treating physician
Schedule in-person interviews with you
Interview your friends, family, co-workers and employees
Demand precise quantifications of how you spent your time in every professional activity pre- and post-disability
Pay your claim under a reservation of rights

What the disability insurance company cannot do

Impose requirements on you that are not contained in your insurance policy
Attempt to influence the opinions of independent medical examiners
Misrepresent policy provisions
Conduct abusive interviews
Unfairly delay a decision on your claim
Fail to conduct a timely, adequate investigation of your disability claim
Destroy key documents
Lie about actions taken on a claim
Place their financial interests ahead of your contractual rights
Force you to litigate by offering an unreasonably low lump-sum buyout

When it comes to claims investigation, disability insurance companies sometimes skirt the limits of what they can legally do. If you believe your insurance carrier might be acting in bad faith, contact an attorney to protect your disability benefits.

The attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff, Sedona, Lake Havasu City, Prescott, and Yuma. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.

Unum’s CEO Gets a $750,000 Increase in Pay for an Annual Income of $12.2 million

admin — Fri, 27 Apr 2012 18:25:12 +0000

While some disabled Unum insureds struggle to make ends meet while fighting unfair claim denials or termination of their benefits, the Times Free Press reports that Tom Watjen, the President and CEO of Unum, received a pay increase of $750,000.00 in 2011 — for a total annual income of $12.2 million — in reward for “delivering strong results in a difficult environment,” according to Unum’s compensation committee.

Watjen receives a base salary of $1.1 million, with the remaining $11.1 million tied to performance-related cash and stock incentives. In 2011, Unum had after-tax earnings of $887.6 million, an 11% return on equity, and $10.2 billion in revenue.

The disability insurance attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff, Sedona, Lake Havasu City, Prescott, and Yuma. We provide disability income claim advice and assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.

Comitz | Beethe an Exhibitor at Osteopath Convention in Scottdale, Arizona

admin — Fri, 13 Apr 2012 23:27:35 +0000

The Phoenix disability insurance law firm of Comitz | Beethe is a Business Partner of the Arizona Osteopathic Medical Association and will be an exhibitor next week at the 90th Annual AOMA Convention at the Hilton in Scottsdale, Arizona. We invite all osteopath physicians attending the convention to stop by our table — Exhibitor Booth #79 near the breakfast buffet tables — to say hello and pick up informational packets about our firm and Arizona disability insurance practice.

The disability insurance attorneys at Comitz | Beethe provide legal representation to protect the disability benefits of medical and dental professionals nationwide and throughout metropolitan Phoenix, Scottsdale, Tucson, Flagstaff and Yuma. We provide disability income claim advice, assistance with filing disability claims, including completion of disability claim forms and representation in disability insurance litigation.

Unum Plays Semantic Games in Denying Benefits for a “Heart Attack”

admin — Fri, 06 Apr 2012 22:49:24 +0000

We have previously blogged that even Unum’s U.K. CEO agrees that Unum’s policies contain confusing language. Recently, Unum took advantage of its unclear disability policy language — in this case, a policy containing the layman’s term “heart attack” — to deny benefits to the widower of a policyholder who had died, in medical terms, of “atheroscopic coronary artery disease.”

Annette Frie’s disability insurance policy from Unum stated that a $30,000.00 benefit would be paid to her spouse if she were to die from a “heart attack.” However, because “heart attack” is not a medical term likely to be used on a death certificate, her husband Jim Frie suspects Unum deliberately used that term on its policy in order to deny claims by splitting semantic hairs.

When Mr. Frie submitted his claim, Unum sent him a letter offering its condolences but denying the claim on the basis that it “didn’t meet the definition of the specified illness covered by the policy.” The medical examiner who had signed Mrs. Frie’s death certificate then sent two letters to Unum explaining that Mrs. Frie’s coronary artery disease had caused the heart attack. In response, Unum denied the claim two more times.

The Minnesota State Commerce Department subsequently opened an investigation, but when Mr. Frie became impatient with the pace of the state’s investigation, he contacted FOX-9 investigators. Within 24 hours of being contacted by the news station about their investigation to expose this “fist-pounding outrage,” Unum called Mr. Frie with the news that the decision had been made to pay the claim.

Even commonly-used words and phrases can take on unexpected meanings within the context of a disability insurance policy, so it is important to consult an experienced disability insurance attorney to interpret the policy language when filing a claim.

FOX-9′s full story can be read here and a video of their news story is below.

Get it in Writing – Why Verbal Communications with Your Disability Insurance Company Can Be Dangerous

admin — Sun, 25 Mar 2012 15:13:02 +0000

We often advise doctors and dentists facing a disability insurance claim to handle all of their communications with the insurance company via mail rather than on the telephone. There are several reasons why written letters are better than verbal communication. For example:

• Claims handlers are trained to ask loaded questions. While the questions they ask may seem routine or mundane to the policyholder, the answers they elicit can have serious consequences that can help the insurance company deny a legitimate claim. For example, a claims administrator might call and ask what you have been doing that day. If you answer that you went out to pick up a prescription, the claims administrator can misconstrue your response as proof that you are not disabled from your occupation. No matter how short or how unavoidable your errand may have been, the insurance company can argue that if you are able to leave the house and perform limited activities, you can still perform your job. If the same question is posed in a letter, you can take the time to carefully consider the question and its consequences, preferably having a disability insurance lawyer help you to answer in a way that won’t be misconstrued.

• Telephone conversations may not be documented accurately. When a claims handler calls a policyholder to discuss his or her disability benefits, the handler will normally write a memo of what was said during the call for the claim file. These memos are used as evidence for disability benefit determinations, and potentially for later litigation. The primary problem is that the memos are written by the claims handler for the benefit of the insurance company, so whether intentionally or not, they are one-sided and biased towards the company’s interests. Another problem occurs when the claims handler doesn’t write a call memo at all; important conversations can be lost entirely. On the other hand, if a policyholder exchanges letters with the insurance company (and keeps copies), the insured can document his or her side of the story without worrying that something will be lost or misreported.

• Insurance companies use jargon that can be hard to understand. As Unum’s UK CEO has admitted, insurance companies use language that is indecipherable to most policyholders. If a claims handler calls you to talk about an elimination period, reservation of rights, ERISA, or the own-occupation definition of disability, you may not be able to completely process what he or she is telling you on the spot. This can cause you to miss important details or inadvertently waive important rights. If the same information comes to you in writing, however, you have time to research the terms and/or get advice from a disability insurance attorney.

For these reasons and more, it is crucial to get communications with your disability insurance company in writing. At the very least, a person filing for disability insurance benefits should take detailed notes of every conversation with an insurance company representative.

Comitz | Beethe Staff Serve the Community Through Animal Protection and Fostering

admin — Thu, 01 Mar 2012 17:30:42 +0000

Comitz | Beethe is always looking for ways to better serve our community as well as our clients. Many of our staff accomplish this goal by providing aid to animals in need.

Libby Thompson, Legal Secretary with the firm, volunteers with the Animal Defense League of Arizona‘s “Trap Neuter Return” or “TNR” program to help humanely control the proliferation of Arizona’s feral cat population. For more information on this program, visit the TNR program’s site.

Patrick Mueller, Office Assistant, was recently recognized for his work as a foster with Urban Rescue, an organization that rescues dogs scheduled for euthanasia in Maricopa County Animal Shelters. Watch this video of Patrick’s rescue of a dog named Abe:

Questions to Ask When Choosing a Disability Insurance Attorney

admin — Tue, 28 Feb 2012 22:52:26 +0000

For those looking for help with their disability insurance claims, choosing an attorney is an important step. However, it can often be difficult to determine whether a particular disability insurance lawyer is the right one for you to work with. Here are some general questions to ask to help you evaluate a potential lawyer or law firm.

1. How many cases does the attorney take on each year?

2. What percentage of the attorney’s practice is devoted to disability insurance claims?

3. Does the attorney exclusively work with individual policy claimants, or does he/she handle ERISA and Social Security cases?

4. Has the attorney published any articles or been interviewed about disability insurance topics?

5. What insurance companies has the attorney dealt with?

6. Does the attorney offer comprehensive representation or short term assistance?

7. Does the attorney’s fee structure work for you?

8. What does the attorney expect to accomplish with your claim?

Selecting the right disability insurance attorney to help with your claim is a decision not to take lightly. You should never be afraid to ask questions, and the attorney will be glad to answer them.

CDC Adds State Level Disability Site

admin — Tue, 07 Feb 2012 17:29:53 +0000

The Centers for Disease Control and Prevention (CDC) recently created a public online database containing state-by-state, disability-specific information. Named the “Disability and Health Data System,” the CDC says that the database can help individuals “better identify health and wellness opportunities for people with disabilities by allowing users to compare over 70 different health measures, as well as data on psychological distress and disability-associated health care expenditures.” For instance, users can access an interactive map with tables showing how often arthritis causes a work limitation for adults in each state.

If you are facing a disability or simply want more information about disabling conditions, the database can be a helpful source of information.

Out of Contract Demands: When You Can Tell Your Disability Insurer “No”

admin — Thu, 02 Feb 2012 17:30:13 +0000

Every disability insurance policy is a contract. With this contract come certain rights and obligations on the part of the disability insurance company and on the part of the policyholder. The insurer promises to pay you disability benefits and you promise to fulfill certain conditions. One of the most important things to remember about this contractual relationship is that if it’s not in your policy, you don’t have to do it.

Often, disability insurers will ask a person filing for benefits to do certain things or provide certain information in order to qualify for benefits. What every policyholder needs to realize is that the disability insurer cannot force you to do something that is not outlined in your policy. There are many examples of disability insurance companies’ demands that may not be required under the terms of the policy, such as:

• That you see a certain type of doctor

• That you undergo surgery for your disabling condition

• That you get a particular treatment or therapy

• That you provide your Social Security or workers’ compensation claim file

• That you attend a certain type of examination

• That you complete detailed descriptions of your daily activities

• That you allow a private investigator into your home

The bottom line is that a policyholder filing for disability insurance benefits should know what their policy requires and what it doesn’t. The best way to be sure an insurer doesn’t get away with making extra-contractual demands is to have a disability insurance attorney review your policy and advocate with the company for your rights.

Even Unum CEO Admits Their Insurance Policy Language Is Confusing

admin — Mon, 30 Jan 2012 16:51:08 +0000

As we have blogged many times, even seemingly straightforward terms like “total disability” or “appropriate medical treatment” in your disability insurance policy may have different meanings in the context of a disability insurance claim than they do in everyday English. In a video posted on YouTube, Jack McGarry, CEO, Unum UK, is surprisingly candid in addressing how confused the average insured is by Unum’s policy language.

Insurance is so confusing, in large part because we’ve made it that way, the insurance companies. We use acronyms instead of words, we use lingo instead of language. We’ve made it easy for us to communicate with each other, but we’ve made it very, very difficult for consumers to understand what we’re saying, and we need to change that.

[Consumers] are confused by our products, they don’t understand the choices, they don’t understand the coverage, and one of the reasons they don’t understand it is because the language we use to describe it, they find it confusing, and a little scary, so we’re partnering with Plain English to help simply the language we use to describe what we do so everybody can understand it.

While Unum is apparently taking steps to clarify the language in its policies in the United Kingdom, it is of little help to American insureds who purchased policies written in language that is, in the words of Unum’s UK CEO, ”very, very difficult for consumers to understand.” The help of an experienced disability insurance attorney to interpret the language of your policy can be critical in ensuring you receive the benefits to which you are entitled.