To protect their businesses and their shareholders, disability insurance companies have made it difficult for the average person to file a claim and obtain the benefits they signed up for. When a person successfully claims benefits on disability insurance, it is lengthy and very expensive for the companies.
Due to the laws governing disability insurance, there are no penalties when companies deny or delay claims. If you have to fight for your disability benefits and it takes a year where you lose your home and savings, there is no penalty or penalty for the disability insurance company. If you win in a lawsuit, you receive what they were supposed to pay you in the first place. The only thing the insurance company loses is their in-house law firm’s time, while people who are sick or injured can lose much more. That’s why it’s important to know as much as you can 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 a staff of nurses and doctors who do nothing but read medical records and review diagnostic tests all day to build cases against plaintiffs. There are many cases we’ve seen where the medical reviewer only sees a small portion of the person’s medical record – important documents that clearly show there is a serious illness are omitted. Is this intentional or just bad records management? It’s hard to know, but the bottom line is that disability insurance claimants have to fight to make sure their full medical records have been examined.
Insurance companies often use internal medical personnel to contact treating physicians, review claims, and write letters that are inaccurate to build cases against plaintiffs. A typical scenario: The medical executive calls the doctor’s office, speaks about the claimant, and then the insurance company employee sends a letter to the doctor’s office confirming the call. The problem is that the letter is not entirely accurate and does not reflect the conversation that took place. Some facts are distorted, others are completely omitted. The crucial part 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, office managers and their own staff are busy and answering this letter is not their top priority. When no one responds, or when the answer 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 plaintiffs’ activities. If you’ve filed a claim and a van or truck shows up near you that doesn’t seem to have any identifying marks or employees removing equipment or making a delivery, it’s very possible that surveillance is taking place. If you have a disability like fibromyalgia where some days you can’t get out of bed and other days you feel almost normal, the video surveillance will only show you on a good day. This can create a tricky situation. However, if your medical records reflect the unpredictable nature of your illness, you’ll have a better chance of challenging your disability insurance policy.