10 More Legal Mistakes Professionals Make When
Filing a Claim for Disability (Mistake #7)

In an effort to provide professionals with more information about how the disability claims process works and identify some of the most common pitfalls for professionals filing disability claims, Comitz | Beethe attorneys Ed Comitz and Derek Funk have compiled an updated list of the 10 most common mistakes we are seeing physicians, dentists, and other professionals make when they file claims under the new post-2000 generation of disability policies (which are much more complex and stringent than the policies sold to professionals in the 1980s and 1990s).

In this post, we’ll be looking at the common mistake of underestimating the aggressiveness of the claim investigation.

Mistake # 7: Being Caught Off-guard by the Aggressiveness of the Claim Investigation

Many professionals do not understand what the claims process entails, and are caught off-guard by the insurance company’s aggressive tactics. One of the most common and first mistakes made by professionals filing a disability claim is assuming that the claims investigation does not begin until after they file the initial packet of claim forms.

While insurance companies used to provide their claim forms online, most insurance companies now require insureds to call the company to request the initial claim forms, so that they can conduct a recorded impromptu interview and collect as much information from you as they can before you have a chance to see the claim forms, review your policy or talk with an attorney about the proper scope of a disability claim investigation. The interviewer may request information about your condition, exactly what you can and can’t do, when you think you will be able to go back to work, the timeline of events leading up to the claim, your exact job duties, and plans for future employment. The interviewer may also ask about your daily schedule, so the company’s private investigators know where to find you when they conduct surveillance, which is now practically an inevitability.

Although the tone of the interview may seem informal and friendly, it is important to recognize that the company’s review of your claim begins from the moment of your first contact with the insurance company, and that, from that point forward, the insurance company will be searching for reasons to deny your claim.

Another common tactic that is now widely used by insurance companies is termed the “peer-to-peer” call. This is something that typically occurs behind the scenes, without any prior notice to the claimant, and involves the insurance company’s in-house doctors contacting your treating physicians directly, in an effort to obtain statements that can be presented out of context as a basis for denying the claim.

As just one example, the insurance company’s doctor may pressure your doctor for a recovery date post-surgery, even though it may be too early to know what will happen. The company’s doctor will keep pressuring until your doctor gives a generalized, estimated recovery date, which the insurance company then characterizes as a “return to work” date. If you are not back to work by then, the company will say your limitations are inconsistent with your own doctor’s opinion, and use the manufactured inconsistency as a basis for terminating your claim. When you go back to your surgeon for clarification, he or she often does not want to get involved any further with your claim, so you are between the proverbial rock and a hard place.

As another example, the insurance company’s doctors often purposefully mislead your doctors regarding how disability is defined under your policy. If you have a true “own occupation” policy, you are entitled to total disability benefits if you can no longer perform the duties of your prior occupation. However, the insurance company’s doctors will ask your doctor to instead opine on broad, irrelevant questions (e.g. “Will the claimant ever be able to work again?”; “Is the claimant’s ability to perform basic activities of daily living impacted by the condition?”) in order to imply that you must essentially be home-bound in order to collect benefits. If you have not taken the time to explain how your policy works to your doctor (to the extent he or she is even interested), your doctor may unwittingly say something that prejudices your claim and, by the time you find out about it, it will be too late to do anything about it.

Action Step: Before calling your insurance company to request claims forms, consult with an experienced disability insurance attorney, review your policy carefully, and take the time to thoroughly prepare for the call.

To read the rest of the 10 most common mistakes, click here.

To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.

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