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Common Disability Insurance Company Tactics Archives

Social Media Causes Long-Term Disability Claimant to Lose her Benefits

In a recent case out of the Fifth Circuit Court of Appeals, Davis v. Aetna Life Ins. Co., No. 16-10895, (5th Cir. 2017), the Court found that surveillance footage and social media were a contributing factor to the denial of the claimant's long-term disability benefits.

Did the 2004 Multi-State Settlement Deter Unum Provident From Continued Bad Faith Claims Handling?

Almost fifteen years ago, Unum Provident entered into a historic multi-state settlement with 3 lead states, 46 other states and the District of Columbia, as well as the U.S. Department of Labor, that cost it in excess of $120 million to comply, required it to reassess claims it has denied dating back to 1997, and called for an additional $15 million in fines. Maine Superintendent at the time, Alessandro Iuppa, was quoted by the Insurance Journal as saying, "This action is one of the most significant multistate insurance regulatory actions in history, providing a uniform, verifiable and effective state-based settlement for the benefit of UnumProvident policyholders nationwide." But did the over $135 million paid by Unum and the substantial, extensive corrective action and requirements of Unum under agreement, along with risk of another $145 million or more in fines, deter UnumProvident from continued bad faith claims handling?

Court Finds Surveillance Video Unconvincing

In many cases, without the claimant's knowledge, insurance companies hire private investigators to follow the claimant and conduct video surveillance over a period of several days. This video is often used to create the illusion that because the claimant is functional and can leave the house they can return to full time work. Often these videos are taken over a 72-96 hour period and show only a few hours of activity during that time. These videos are misleading; nonetheless they are used to deny or terminate benefits or to frighten claimants into agreeing to a settlement of their claim, much lower than their claim is actually worth.

Is A Physician Who Is No Longer Able To Perform Surgery Totally Disabled Under An Own Occupation Disability Insurance Policy?

Numerous cases exist where a physician who has specialized as a surgeon becomes unable to perform surgical procedures due to injury or illness but remains able to still perform other duties as a physician. Whether or not this is considered a total or residual disability benefits claim is contingent upon the specific disability insurance coverage you have with your insurance company. Insurance companies frequently either deny these types of disability claims by physicians outright, or attempt to pay these claims only as "residual disability," which usually involves a much reduced disability income benefit when compared to the "total disability" benefit at issue. There is legal authority to support the position that a physician who is no longer able to perform surgery is totally disabled under own occupation disability insurance coverage, particularly where "specialty" own occupation disability insurance coverage is at issue. However, having a disability insurance claim approved by an insurance company as such is another story entirely.

Getting and Keeping Your Disability Insurance Benefits

Applying for disability insurance benefits and maintaining those benefits requires an understanding of the policy's terms as well as the tactics and review procedures utilized by many insurance companies throughout the duration of the disability claim. During the application process, many insureds are surprised to learn that having a significant medical condition and statements from their own physician(s) certifying disability are not considered sufficient proof of claim. Companies including, but certainly not limited to Unum, Hartford, Cigna, Prudential, Assurant, Lincoln Financial, Liberty Mutual, Standard and Aetna ask their insureds to jump through numerous hoops before determining whether or not the claim will be approved. Additionally, from the onset of the claim and throughout the ongoing evaluation process, adjusters often manipulate the information received by the insured and his/her doctor in attempt to secure a claim denial or set the claim up for denial at some point in the future.

Pre-existing Condition Exclusions Are Often Misused by Companies to Deny Disability Insurance Claims

Most every group long-term disability policy will include a complete exclusion for any disabilities caused by a pre-existing condition. Private long-term disability insurance policies purchased by individuals normally also exclude coverage for a pre-existing condition unless higher premiums are paid for special coverage that does not include the exclusion. Exclusions such as the pre-existing condition exclusion are often misused by companies to avoid paying disability insurance claims in effort to save a company billions of dollars, and is another common tactic used by companies to delay or deny payment of legitimate claims.  Whether a condition is legitimately "pre-existing" (and thus excluded from coverage) or not depends upon the provisions in the policy applicable to disabilities caused by a pre-existing condition. The disability policy language related to pre-existing condition exclusions can vary greatly, and even the slightest distinction could mean the difference between your disability being covered or entirely excluded from coverage under the policy. Given that the disability income benefits at issue under these policies are customarily paid through age 65 or even lifetime, whether the disability is actually excluded under the policy according to the law governing these matters is hugely significant.

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