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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10 More Legal Mistakes Professionals Make When
Filing a Claim for Disability (Mistake #8)

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 having an inaccurate expectation of how the claims process works, and what it entails.

Mistake #8: Misunderstanding the Scope of the Investigation

Disability insurance companies have substantially broadened the scope of claims investigations over time. While many professionals expect and anticipate that the insurance company will review their medical records and ask for reports from their treating doctors, many professionals are surprised when the insurance company also requests a long list of additional information as part of the claim investigation, including tax and financial records of personal accounts, businesses, and trusts. Whereas many older policies merely required insureds to simply submit to a physical examination while the claim was pending, new policies grant disability insurance companies the right to require their insureds to undergo a host of other examinations, including vocational and rehabilitation examinations, occupational analyses, and psychiatric evaluations, and threaten suspension of benefits if the insured refuses to cooperate. As you might suspect, in most cases the insurance company’s evaluators are not incentivized to make fair decisions.

Action Step:  Review your policy carefully and consult with an experienced disability insurance attorney prior to filing your claim, so that you know what the insurance company can and cannot do when investigating your claim.

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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10 More Legal Mistakes Professionals Make When
Filing a Claim for Disability (Mistake #9)

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 not understanding how the care provision in your disability insurance policy impacts your disability claim.

Mistake #9: Allowing the Insurance Company to Dictate the Terms of Your Care

Many disability insurance policies now condition receipt of benefits on compliance with stringent care requirements. In contrast to older policies, which typically required an insured to obtain “regular care,” many newer policies require insureds to obtain care designed to achieve “maximum medical improvement.” While the older regular care requirements provided little leverage for insurance companies to require insureds to obtain specific treatments or procedures, these new requirements give them leverage to argue that an insured must undergo treatment that arguably could enable the insured to return to work. In some cases, the insurance company may go so far as to demand surgery, leaving the insured with the choice of undergoing an operation involuntarily and bearing all of the medical and financial risks himself or herself, or potentially giving up his or her right to collect benefits.

Action Step:  Contact an experienced disability insurance attorney to ensure your rights are protected if your insurer attempts to dictate the terms of your care.

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

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 cancelling an existing policy and getting a newer policy, without fully understanding or considering how this decision can impact your chances to collect benefits if you ever need to file a claim.

Mistake #10: Replacing Your Old Policy with a New One

Many professionals decide to replace older, smaller value policies with a new policy with a higher monthly benefit, once they reach the point that they can qualify for a higher benefit amount. While this can be more convenient (because you don’t have to keep track of multiple premiums, or file with multiple companies if you end up needing to file a disability claim), generally speaking, older disability policies have more favorable policy definitions and better coverage for professionals. So, if you do have an older policy, it may be better to supplement that coverage, rather than replace it.

Another important consideration to keep in mind when assessing whether to replace existing coverage is that canceling an existing policy and choosing a new one resets pre-existing limitation periods that may have already been satisfied under the older policy. Additionally, if you purchase a new policy, you will likely have to go through the medical underwriting process again and, as a result, conditions that would have been covered under the older policy may be excluded from coverage altogether under the new policy.

Action Step:  Carefully review the pros and cons of replacing an existing policy before cancelling it or letting your policy lapse due to nonpayment of premiums.

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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