To protect their businesses and their 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 person successfully presents the benefits of a disability insurance policy, it is long-term and very expensive for companies.
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 life savings, there is no penalty or penalty for the disability insurance company. If you win in a short case, you will receive what you were supposed to be paid in the first place. The only thing the insurance company loses is their in-house law firm’s time, while sick or injured people stand to lose much more. That’s why it’s important to know as much as possible about disability insurance, the process for 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 but 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 that clearly verify serious illness are left out. Is this deliberate log management or just poor? It’s hard to say, but the bottom line is that disability insurance claimants have to fight to make sure their complete medical records have been reviewed.
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, discusses the claimant, and then the insurance company staff member sends a letter to the doctor’s office to confirm the conversation. 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 left out entirely. The critical part is this: the letter will contain a statement that says “unless we hear from you before (a certain date), you accept the statements in the letter as fact.”
Physicians, office 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 agreement with 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 claimant activities. If you’ve filed a claim and a van or truck shows up on your block that doesn’t appear to have any identifying markings or workers pulling equipment or making a delivery, surveillance may be underway. 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.