To protect their businesses and shareholders, disability insurance companies have made it difficult for the average person to file a claim and get the benefits they signed up for. When a successful person applies for benefits on a disability insurance policy, it is long-term and very expensive for businesses.
Because the laws governing disability insurance policies were written, there are no penalties when companies deny or delay claims. If you have to fight for your disability benefits and it takes a year, during which time you lose your home and your life savings, the disability insurance company will not receive any punishment or penalty. If you win in a court case, you will receive what they were supposed to pay you in the first place. The only thing the insurance company loses is its in-house law firm time, while sick or injured people can lose much more. That is why it is important to know as much as possible about disability insurance, the process of filing a claim, and the process of fighting a claim to protect yourself.
Insurance companies employ many medical professionals to investigate claims. They have staff of nurses and doctors who do nothing more than read medical records and review diagnostic tests around the clock to build cases against claimants. We have seen many cases where the medical reviewer only sees a small part of the person’s medical record; Important documents clearly verifying a serious illness are omitted. Is this deliberate or just poor records management? It’s hard to tell, but the bottom line is that disability insurance applicants have to fight to make sure their complete medical records have been examined.
Insurance companies often use in-house medical staff to contact treating physicians, review claims, and write inaccurate letters to help build cases against claimants. A typical scenario: The medical staff member calls the doctor’s office, talks about the claimant, and then the insurance company employee sends a letter to the doctor’s office confirming the conversation. The problem is that the letter is not entirely accurate and does not reflect the conversation that took place. Some facts are skewed, others are completely omitted. The bottom line is this: the letter will contain a statement that says “unless we hear from you by (a certain date), you accept the statements in the letter as fact.”
Doctors, practice managers, and your own staff are busy and responding to this letter is not your top priority. When no one responds, or when the response comes after the date, the insurance company uses that as an agreement to the content of the letter, even if the letter is totally inaccurate and contradicts all the information in the patient’s medical record.
Today it is economical for insurance companies to use video surveillance to monitor the activities of claimants. If you have filed a claim and a van or truck appears on your block that does not appear to have any identifying markings or workers removing equipment or making a delivery, it is very possible that a surveillance is being conducted. If you have a disability like fibromyalgia, where some days you can’t get out of bed and other days you feel almost normal, video surveillance will only show you on a good day. This can create a difficult situation. However, if your medical records reflect the unpredictable nature of your illness, you have a better chance of fighting the challenge of your disability insurance claim.