The Evolution of Disability Policies: Part 3: Authorizations
In Part 3 of our series on the evolution of disability insurance policies, we’ll be looking at provisions related to the authorizations insurers use to investigate disability claims.
Older policies typically contain a brief, more generic provision that mentions authorizations, such as this:
Authorizations. From time to time, the Company will furnish the Insured with authorizations to obtain and disclose information. These authorizations must be signed by the Insured and returned to the Company.
Newer policies seek to go far beyond that, and not only expand the language relating to authorizations, but also incorporate serious consequences for failing to execute authorizations. For example:
The applicant or insured Member will cooperate with the Company’s efforts to obtain this information and will execute any necessary releases or authorizations. The Company shall have the right to communicate with any accountants or other bookkeeping professionals, medical professionals, medical providers or other insurers.
Failure of an applicant or insured Member to cooperate with any of these requirements may, independently of other information provided, result in: (1) rejection of an application for insurance; (2) delayed benefit payments; or (3) denial, suspension or termination of benefits.
The Company’s decision to forego obtaining any particular information does not prevent it from subsequently requiring such information.
For frame of reference, here is an example of what these sorts of authorizations say:
I AUTHORIZE THESE PERSONS OR ENTITIES having any records or knowledge of me or my health to disclose that information to [insurance company]: • Physician, therapist, healer, or medical practitioner • hospital, clinic, pharmacy, pharmacy benefit manager or other medical or medically related facility or association • other health care provider • insurance company or insurance support organization • employer, business associate, group health plan, or plan administrator • motor vehicle or driver licensing agency, law enforcement agency, or other government agency • agency, organization or entity administering a benefit program, • educational, vocational or rehabilitation organization or program • consumer reporting agency, financial institution, accountant, tax preparer or • other persons or institutions
As you can see, these authorizations can be extremely broad in scope. Sometimes the requested information is relevant to the underlying claims investigation, but in other instances the company may just be fishing for additional information about you that has little to no bearing on the nature of the claim being made.
Whether or not a request is proper often depends on the particular facts and circumstances and policy definitions in play, so it is important for you to read your policy carefully and become informed about the how the claims process works.
Every claim is different, and these are just some examples of authorization provisions taken from different policies. Your policy may contain different and/or additional language that could impact your particular situation. If you are unsure about the terms of your policy, or how a provision applies to your specific situation, you should contact an experienced disability insurance attorney.