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.
Completing the application and dealing with the initial telephone conversations with the carrier is a confusing and time consuming process. It may, however, be the most important part of the claim for benefits. Claims representatives rely heavily on the information and documents submitted during the application phase as the basis for their initial claim determination and continuing evaluation of the claim. Thus, it is vital that the application is properly completed and the claim sufficiently supported by the client’s own statements. The initial telephone call to the insured is often used to “box” the insured into certain parameters and admissions; making it difficult for the insured to clarify or correct the adjusters understanding of what was communicated. Insurance companies also manipulate the information conveyed in medical records and by the treating physician him/herself. For example, an independent physician who is either an employee of the insurance company or hired by the company is paid quite well to review the medical records and summarize the findings. Overwhelmingly, the independent review results in a finding that the medical records do not contain enough specific evidence that the insured has limitations which prevent him from working and benefits are terminated. Even more concerning is that the insurance carrier’s doctors will contact the insured’s treating physician directly in an attempt to convince the treating doctor to concur that the insured is possibly capable of working or will be able to return to work in several months. It should also be noted that one of the most important aspects of a claim, whether it’s the application phase or the ongoing administration of the claim, is the attending physician’s form. When not completed properly this form is often used by insurance companies to deny claims. As such, being able to work directly with the insured’s treating physician(s) is important to help them understand how the term “disabled” is defined under their patient’s particular policy and the specific information being sought by the carrier. At DI Law Group we handle claims at all levels, from the application process, to ongoing claim administration, to filing an appeal or lawsuit to make sure our clients receive the benefits to which they are entitled.
Recently, insurance companies have been approving claims fairly quickly in order to make their claim approval rate look high for marketing and statistical purposes; but then terminate benefits within 12 – 24 months based on new information. Typically this new information consists of activities observed during videotaped surveillance; a biased independent physician’s review of the medical records; information or observations obtained during an in person interview; and/or the results of a Functional Capacity Examination or Independent Medical Examination scheduled by the carrier with a physician with whom they are familiar. Thus, from the application phase of the claim and throughout the ongoing evaluation of the claim, it is important to understand how your particular insurance company handles the process and what tactics will be utilized to deny or limit benefits.
The attorneys at DI Law Group have extensive experience representing disability income claimants and are happy to discuss these questions and any other important issues during our free consultation. We represent clients throughout the nation and have attorneys that are able to practice in numerous states. Contact us today at www.dilawgroup.com or (866) 363-3628 for the answers and experienced legal help you need.