Filing a Claim Under an Individual Disability Policy
At Disability Insurance Law Group, our attorneys represent claimants at all stages of the disability insurance process. Many disability insurance claim denials can be prevented by effectively preparing your insurance benefit application. Many denials can be overturned prior to suit, by challenging the insurance company’s basis for denial and collecting the right information to support your claim. Often this includes obtaining expert medical, vocational and/or financial opinions.
We will aggressively negotiate with the insurance company to help resolve any dispute regarding your injury or illness. Moreover, if the insurance company refuses to overturn a wrongful denial, we aggressively fight to protect our client’s rights at trial. Contact us today to learn more in a free consultation.
One of the most important aspects of a claim for disability benefits is completing the application and submitting it to the insurance carrier. While the application typically looks straightforward and easy to complete, the information you provide can mean the difference between proving your claim and foreclosing your right to benefits. As such, completing the application should not be taken lightly.
Remember, your insurance carrier prepared the application and thus, typically the format is set up to benefit your insurance carrier, not you. Often, there is only limited room to explain your condition, symptoms, limitations and restrictions, and your numerous occupational duties. Moreover, the questions are often posed in such a way that they elicit certain unfavorable answers.
It is essential that you thoroughly explain your condition and occupation, regardless of restrictions posed by the application. It is even more important that you carefully complete your application and not be tricked into statements that can later be misconstrued. It can be invaluable to understand what your insurance company is looking for to deny or limit payment under your policy before you prepare your application or answer your insurance company’s questions.
Unaware of the right to assert a reasonable amount of time to complete the application, many applicants are encouraged to provide careless answers because their insurance company demands the submission of the application within a very short period of time. Without fully understanding this, many truly disabled applicants unknowingly damage their claims by providing incomplete answers and mistakenly misinterpret the questions posed.
A successful application for benefits will contain sufficient proof of loss, including proper documentation. This involves collaboration between the applicant, the treating physician(s), the applicant’s accountant and his/her employer.
Many times, it is necessary to obtain the opinions of independent medical, vocational and/or financial experts to prove the claim. Most insurance carriers employ their own experts and staff to scrutinize each claim.
Treating Physician and Attending Physician Forms
Often an insurance company will require the applicant’s treating physicians to complete an Attending Physician Statement. The treating physician is required to determine whether the patient can perform the duties of his/ her occupation or, in some instances, of any other occupation. Many times, the insurance company will call or meet with the physician in order to discuss the claimant’s condition. Typically, the physician is not made privy to the claimant’s occupational duties or definition of “total disability” prior to completing the report.
While the insurance companies refer to this as a “peer to peer” conversation to obtain an understanding of the claimant’s condition and treatment, often the physician that contacts the treating doctor is an employee of the insurance company, trained to ask questions that elicit specific responses.
Many of our clients who retained us after their treating physician had spoken to the insurance carrier, complained that their physician was asked very limited and pointed questions, without an opportunity to fully address the claimant’s limitations. Many physicians simply do not understand the process and thus may be misled into making statements that can be taken out of context to support a denial or into not providing sufficient information to support their patients’ claims.
We regularly consult with our client’s treating physicians, so that they are able to properly evaluate and communicate whether the patient’s restrictions and limitations prevent him / her from performing the duties of the claimant’s actual occupation. Moreover, it is essential that the treating physician is aware of the insurance carrier’s misleading questions, so that they are able to fully explain how the claimant’s condition limits the patient’s ability to work.
Insurance companies often require an in-person or telephone interview with a claimant early on in the process. Insurance companies spend an enormous amount of time and energy training their claims examiners and investigators on how to handle a claim. They understand how to ask questions that will illicit information that can later be misconstrued or taken out of context. This frequently provides insurance carriers with the ammunition needed to deny or delay payment of a claim.
We do not allow our clients to attend an in-person or telephone interview without our presence. We fully prepare our clients for what they will face prior to the interview and limit the interviewer’s ability to ask ambiguous and unfair questions. Moreover, we take copious notes regarding the questions asked and the responses given and often provide a summary to the insurance company so that the claims examiner cannot later misrepresent what occurred during the interview.
Independent Medical Examination
Insurance carriers often require claimants to attend an “independent” medical examination (IME). The examiners are chosen and paid for by the insurance companies. The attorneys at Disability Insurance Law Group only allow our clients to attend independent medical examinations after careful negotiations about the appropriate physician, the physician’s specialty, the tests to be conducted and the scope of the examination.
Typically, we will attend the examination with our client or have it videotaped to insure an unbiased account. While most policies allow the insurance company to demand an IME and chose the physician, that right is not without limitations. It is important to know your rights and obligations under your policy and the law.
In most 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 attempt to create the illusion that the claimant is less than truthful based on answers provided during the field interview. This is often done 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. Claimants should be aware of their rights before agreeing to a settlement. Often, the surveillance video is unreliable and misleading. However, without addressing the flaws in the surveillance video, insurance carriers often get away with these tactics. We typically request a copy of the surveillance video to address these issues and allow our client’s treating physicians an opportunity to review and comment before any decision is made.
Insurance companies typically obtain surveillance video periodically throughout the entire process. It is not uncommon for a claimant to be under surveillance multiple times during his/her claim. Also, insurance companies frequently order the surveillance of claimants at specific stages in the process and occasionally will “create” scenarios to obtain video that is not truly representative of a claimant’s abilities. We thoroughly educate our clients on when and how insurance carriers often seek to obtain surveillance video.
While claimants do have an obligation to provide sufficient evidence to prove their claim, claimants must be aware that insurance companies are not entitled to everything that they request. Insurance carriers are only entitled to relevant information to the claim of disability. Without understanding the legal implications of the documents requested by the insurance carrier, claimants often needlessly provide irrelevant information that can be unjustly used to confuse the issues at hand.
Contact Us for Guidance in the Disability Claim Process
To discuss your legal rights pursuant to any disability insurance claim, please contact our office by email to schedule a free and informative consultation with an experienced attorney. Or call us at 866-363-3628.