To protect their businesses and their shareholders, disability insurance companies have made it hard for the average person to file a claim and obtain the benefits that they signed up to receive. When a person successful files for benefits on a disability insurance policy, it is long-term and very expensive to the companies.
Because of the laws governing disability insurance policies were written, there are no penalties in place 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 life savings, there is no punishment or penalty to the disability insurance company. If you win in a court case, you will receive what they were supposed to pay you in the first place. The only thing that the insurance company loses is the time of their in-house law firm, while people who are sick or injured 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 for a claim to protect yourself.
Insurance companies employ many medical professionals to investigate claims. They have staffs of nurses and doctors who do nothing but read medical records and review diagnostic tests all day long to build cases against claimants. There are many instances that we have seen where the medical reviewer only sees a small part of the person’s medical file – important documents that clearly verify a serious illness are left out. Is this deliberate or just poor record management? It is hard to know – but the bottom line is that disability insurance claimants have to fight to make sure that their complete medical records have been examined.
Insurance companies often use in-house medical staffers to contact treating physicians, review claims and write letters that are not accurate to help build cases against claimants. A typical scenario: the medical staffer calls the doctor’s office, speaks about the claimant, and then the insurance company staffer sends a letter to the doctor’s office confirming the conversation. The problem is, the letter is not entirely accurate and does not reflect the conversation that took place. Some facts are twisted, others are left out entirely. The critical part is this: the letter will contain a statement that says “unless we hear back from you by (a certain date), you accept the statements in the letter as fact.”
Doctors, office managers and their own staffers are busy, and responding to this letter is not their top priority. When no one responds, or when the response comes after the date, the insurance company uses that as an agreement with the contents of the letter, even if the letter is totally inaccurate and contradicts every piece of information in the patient’s medical record.
Today it is inexpensive for insurance companies to use video surveillance to monitor claimant activities. If you have filed a claim and a van or truck shows up on your block that does not seem to have any identifying marks or workers taking out equipment or making a delivery, it is entirely possible that surveillance is taking place. If you have a disability like fibromyalgia, where some days you cannot get out of bed and other days you feel almost normal, the videotape surveillance will only show you on a good day. This can create a difficult situation. If however your medical records reflect the unpredictable nature of your illness, you have a better chance at fighting the challenge to your disability insurance claim.