Common Insurance Company Tactics
As part of the unequal claims handling process, aggressive and confusing tactics are often employed to manipulate claimants and their physicians into making statements that can be misconstrued and used to support a denial of benefits. In the initial application and throughout the claims process, the insurance company’s interest in minimizing payouts is often better-protected than the rights of the policy-holder.
If your benefits have been unfairly denied or delayed, it can be of enormous benefit to discuss your options with an attorney who understands the common insurance company tactics used to justify claim denial or delay.
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 or 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. 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.
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 or 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.
The “Independent” Medical Examination (“IME”)
Often, insurance companies require claimants to attend “independent” medical examination by a physician selected and paid for by the company. Most insurance policies have a requirement that claimants submit to such an examination at the insurance company’s discretion. However, there are often restrictions to the type of IME that is requested.
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.
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 often place claimants under surveillance during particular stages in the process and in conjunction with other investigative tools used to obtain information from claimants such as field interviews, activities of daily living forms and independent medical examinations. Having an idea of when and your insurance company may utilize surveillance or how it is typically done can be essential to your claim or appeal.
Requests for Information
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.
Knowledge is Power
Knowledge of these tactics and an understanding of your rights and obligations under your policy are essential to maneuvering through the disability insurance minefield. Ultimately, your knowledge — and the knowledge of your legal representative — can substantially improve your chances of successfully obtaining benefits.
The lawyers at Disability Insurance Law Group guide claimants and advance their rights through all stages of the process. We prepare our clients for and attend interviews, review all forms submitted for information that can be taken out of context, and collaborate with attending physicians to help them understand our clients’ occupational requirements and the importance of clearly documenting our clients’ limitations and restrictions. We are committed to aggressively fighting for the benefits our clients deserve.
Get Experienced Legal Help
The attorneys at Disability Insurance Law Group will discuss your case with you and examine your policy and other documentation. We will answer your questions, help you develop a strategy for your claim and explain the advantages and pitfalls of every issue so that you can make informed decisions about your case
The team at Disability Insurance Law Group has faced a number of large regional, national and international disability insurance carriers on behalf of our clients, including:
|Aetna||American General Life (AIG)||Assurant||Berkshire|
|Broadspire||CIGNA||Continental Casualty (CNA)||Equitable|
|Genworth (GE)||Guardian||Hartford||Illinois Mutual|
|Jefferson Pilot||John Hancock||Liberty Mutual||Lincoln Financial|
|Mass Mutual||MetLife||Monarch||New York Life|
|Northwestern||Ohio National||Paul Revere||Principal|
|Provident Life & Accident||Prudential||Reliance Standard||Sedgwick CMS|
Do Not Let the Insurance Company Manipulate You — Get Help From Our Firm
Contact our offices to arrange for a free initial in-person or telephone consultation, or call our offices at 954-633-8811. We will listen to your concerns, evaluate your case and advise you of your legal options.