Can My Disability Insurance Company Contact My Employer?
We previously posted about the breadth of authorization forms that disability insurers request you sign at the beginning of your claim for disability insurance benefits. These forms allow your insurance company not only to obtain medical records and other relevant information, but also to contact your employer to discuss your specific job duties, among other things.
This can be unsettling as you may not want your employer to know about your medical condition, or you may fear what your employer might say that could jeopardize your disability claim. Unfortunately, there is little that you can do to stop the interview from occurring, but you can prepare yourself and your employer beforehand.
Most policies require that, in order to be considered “Totally Disabled,” you must be unable to perform the material and substantial duties of your occupation, and be under the regular care of a physician. Accordingly, your insurance company needs to ascertain your important occupational duties.
If you can still perform some of your important occupational duties, though not all of them, you will not be considered “Totally Disabled” under most policies. It is important, therefore, to anticipate that your insurer will contact your employer so that you can ensure that only accurate and relevant information is communicated.
There is a critical difference between important occupational duties, and those that are merely incidental. Duties that encompass only a small percentage of your time are incidental or peripheral duties and not part of your regular profession. It is therefore improper for your insurance company to consider these duties when determining your eligibility for disability benefits.
For example, a licensed dentist who works 90% of the time treating patients and 10% of the time on administrative duties is regularly engaged in chair dentistry for purposes of an own- occupation disability insurance claim. Administrative work such as overseeing office staff, paying bills or attending continuing education classes are merely incidental to his material and substantial duties as a full-time dentist.
By focusing on insignificant duties, and getting your employer to sign off on those duties as important parts of your regular occupation, your insurance company will have made it much more difficult for you to collect your rightful benefits. While this is an unscrupulous practice, it often occurs and produces an unfair result. Considering each and every incidental duty and allowing a finding that you are Totally Disabled only if you are unable to perform each and every one of those duties is a nitpicking approach that would equate Total Disability with utter helplessness. Obviously, that is not the type of coverage that you purchased, nor what had been marketed to you at the point of sale.
To ensure that your employer does not provide misinformation to your insurance company during the interview, here are some tips:
Prepare an Occupational Description: Prepare an occupational description listing your important duties and have your employer sign off on it. Then provide the occupational description to your insurance company at the beginning of your claim. By reviewing this document with your employer, it will be less likely that your insurance company will be able to focus on the irrelevant, incidental duties of your job.
Explain How Your Policy Works to Your Employer: Let your employer know that you have an occupation-specific policy that entitles you to benefits if you cannot perform the important duties of your job. Further explain that your occupational description is intended to outline your important duties, and other duties you may perform are merely incidental. This way, you are focusing your employer on what’s relevant and preparing him or her for the interview.
Being prepared and vigilant at the beginning of your claim increases the likelihood that you will be paid the disability insurance benefits that you deserve.
