Disability Insurer Profiles #1: AIG
The American International Group first began operating as a small general insurance business in Shanghai, China. Since then, AIG has acquired at least nine major insurance companies and now operates worldwide. AIG was frequently in the news about ten years ago, when the United States government paid $182 billion to bail out the company.[1] AIG has since recovered, reporting about $498.3 billion in total assets in 2017.[2]
If you have an AIG policy, it is important that you review and understand how the policy defines your “occupation” in the context of a disability claim. Many physicians think their occupation will be defined as what they put down on the initial policy applications, or think it means the “primary” occupation that they are engaged in. However, under most disability policies (particularly newer disability policies), that is not how “occupation” is defined. Under most disability policies, your occupation can change if you take on new responsibilities and/or new positions prior to filing your disability claim.
For example, the case of Hayes v. AIG[3] involved a physician who filed a “total disability” claim for severe back pain, neck pain, and numbness following a head injury. When he filed his claim, the doctor identified his occupation as “physician” with a specialty of “occupation medicine.” However, in addition to his duties at the hospital, the doctor also worked part-time performing acupuncture. At some point after being awarded “total disability” benefits, the doctor returned to work. The doctor maintained he was working in a different capacity than his specialty of “occupation medicine”; however, the work included acupuncture.
The policy defined “current occupation” as “the duties of the medical specialty then being practiced or of the occupation being performed immediately prior to the disability” (emphasis added). AIG argued that this definition encompassed all of the duties the doctor engaged in prior to disability, including acupuncture, and maintained that the doctor’s return to acupuncture precluded a finding of “total disability.”
This particular case was hard-fought by both sides, and when the doctor’s attorney sued AIG, the court ultimately ruled against the doctor on several other legal issues. But this back-and-forth regarding how this definition of “occupation” should be interpreted illustrates why it is important to understand what your policy says before filing, if you want to avoid costly, time-consuming litigation.
With respect to AIG’s claim administration, AIG often pays doctors to evaluate claims made under its policies. These doctors are usually asked to conduct “file reviews” of the available medical records and render an opinion, without personally examining the claimant.[4]
In some instances, insurance companies use these “file reviews” as a basis for generating follow-up questions and/or justifying requests for in-person medical examinations. But, in other instances, you may not find out that the reviewing doctor was looking at your records until you receive notice that your claim is being terminated or denied. Accordingly, it is important that your symptoms, limitations and treatment are all consistently and accurately reported in your medical records.
These are just a few examples of things to be aware of if you have an AIG policy or claim with AIG. Not all AIG policies are identical, and they are updated frequently. Your policy may or may not include the provisions mentioned above. If you are considering filing a disability claim, you should consult with an experienced disability insurance attorney to learn more about your policy and any potential issues related to your particular claim.
[1] https://www.treasury.gov/press-center/press-releases/Pages/tg1703.aspx
[2] http://annual.aig.com/ui/2017/docs/AIG-2017-Final-Annual-Report.pdf
[3] See Hayes v. Am. Intern. Group, 2014 WL 3746813 (E.D. Penn. July 29, 2014).
[4] See, e.g., Adair v. El Pueblo Boys & Girls Ranch, Inc., No. 11-CV-02749-WYD-KLM, 2013 WL 4775927 (D. Colo. Sept. 5, 2013).
