What Issues Am I Most Likely to Face Handling My Claim Alone?

Disability insurance claimants face many obstacles in their efforts to successfully file a claim or reinstate benefit payments. Among these hurdles are:

    • Interpreting and following the terms of complicated policies drafted by insurance companies;
    • Dealing with insurance companies’ efforts to delay the claim process and wear out the insured;
    • Convincing treating physicians to take the time and effort to properly document the disability;
    • Surveillance by insurance companies, which is often taken out of context or is not indicative of a claimant’s ability to work, but is nonetheless used as a basis for denying or terminating a claim;
    • Ensuring independent medical examinations are conducted fairly and without risk of injury;
    • Preventing insurance companies’ efforts to deny or terminate claims where the symptoms are subjective or self-reported; and
    • Overcoming the vast array of other techniques that insurance companies use to design a case for denying legitimate disability insurance claims.

Complicated Insurance Policies

Insurance companies draft complex, confusing policy documents. The companies often take advantage of this complexity when denying claims. There is no such thing as a standard policy. Disability provisions vary greatly in the language used, and coverage is often circumscribed and restricted by qualifying words and phrases. It is crucial to understand the specific definitions of the key terms in your individual policy so that you can file an accurate and complete disability insurance claim.

Undue Delays

Insurance companies may try to wear you down by drawing out the disability claims process for as long as possible. These delays can be frustrating, as they can keep you from getting your benefits. Insurers have a duty to make prompt decisions, so you should not have to tolerate undue delays.

Cooperation From Your Treating Physician

Your treating physician’s support can often be critical to getting your claim approved. A hurried, uninterested physician may not have time to devote to your disability insurance claim. In addition, fully discussing your condition with a professional, compassionate treating physician will help ensure supportive medical records. When to discuss your potential disability insurance claim with a physician is an important timing issue.

Surveillance

Once you file your disability insurance claim, you will likely be videotaped or photographed by your carrier at some point in time. If you are caught on tape engaging in any activities that you claimed you could not perform, your benefits will likely be denied and your contract could be terminated.

Independent Medical Examinations

After submitting your claim, you may be asked to submit to an “independent” medical examination by someone chosen and paid for by your insurance carrier. You may also be asked to undergo exams by someone other than a physician. Independent medical examinations can be problematic. The examiner is often biased towards the insurance company. Additionally, the proposed exam could include protracted or intrusive diagnostic tests. Because the “independent” medical exam is a tool used for denying disability benefits where possible, you should work to ensure that your rights are protected during this process.

Subjective Conditions and Self-Reported Symptoms

Insurance carriers often deny disability insurance benefits for conditions such as back and neck pain, rheumatoid arthritis and depression, insisting that the insured’s subjective symptoms do not provide objective, verifiable evidence of disability. In many cases, there is no provision or contractual requirement mandating that the insured submit objective evidence of disability. Therefore, from the insured’s perspective, these insurance companies are merely trying to save money by generously interpreting policy language in favor of claim termination. In addition, these companies appear to be taking advantage of flaws in medical science, which has not yet progressed to the point of creating methodologies for objectively testing and identifying certain conditions. You should understand your policy’s limitations and work with counsel on submitting your claim in such a manner as to ensure payment of benefits.

Other Issues to Consider

There are numerous other obstacles to consider when it comes to dealing with your disability insurance company. The insurer may ask you to submit to a Functional Capacities Evaluation (FCE). The company may also conduct extensive audits of your billing records. Insurers are also known to demand precise quantifications of time spent in every professional activity. In today’s economy, many insurance companies are undergoing economic pressures that create more incentive than ever for them to find ways to terminate or deny claims.

These Obstacles Can Be Overcome

Carriers often purposely make the disability insurance claim process as daunting as possible, with numerous tricks and pitfalls, in an effort to undo the policy definitions that they created. None of these problems is insurmountable; however, they are certainly difficult to tackle alone, against a billion dollar industry with particular expertise in saving money. When faced with a possible disability insurance claim, you should consult with an attorney experienced in this area of the law so that you can understand your policy and maintain control over your financial future.

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