Disability insurance carriers terminate/deny long-term disability insurance claims routinely. Most insureds are in the dark regarding their insurers’ intentions and are left to wonder whether theirs will be the next claim to be terminated. Having practiced in this area for many years, we’ve come to recognize those red-flags that signify that an insured’s claim has been targeted for termination. Here are the top 10:
1. Your Insurer Schedules a Field Visit. Disability insurance carriers schedule interviews with claimants when they want to collect information to use against the claimant. You may think the carrier’s representative – who is likely an investigator – is genuinely interested in how you are doing; indeed, many investigators seem friendly and likeable. Make no mistake about it – the investigator has been paid to investigate you. The investigator will want to meet you at your home so that he/she may collect information. Indeed, he/she intends to interrogate the insured, collect information concerning the insured’s home, wealth and living situation. In turn, the investigator will write a report to the carrier who will pay for his/her time and then use this report against you.
2. Your Disability Insurance Carrier Requires You to Undergo a Physical or Mental Status Examination. These examinations are usually called “independent medical examinations” or “functional capacity evaluations.” In fact, we have found that these examinations are anything but “independent.” These exams can be as short as fifteen minutes and as long as six hours. Doctors, who are paid by the insurance carrier, examine the claimant and prepare a report that is submitted to the insurance carrier, which, in turns, pays the doctor hundreds/thousands of dollars for his/her time. Most often, these reports are grossly unfavorable to the claimant and are used by the disability insurance carrier to deny or terminate a claim.
3. An Increase in Frequency of Claimant Statements and Attending Physician Statements. All claimants receive requests from their carriers to complete claimant statements and for their doctors to complete attending physician statements. However, the frequency a claimant receives these requests for information is crucial. If you are receiving requests for information more than twice a year, it is likely your claim has been targeted or, at the very least, is under heightened scrutiny by the insurer.
4. Surveillance. This is one telltale sign that you have been targeted for termination. The only problem is that the carrier does not notify the claimant that he or she will be watched by insurance investigators. Their purpose is to catch you on tape doing something that you said you couldn’t do or not doing something that you say you always do. For example, if you say you use a cane to get around, the insurance company will be looking for the 10 minutes of one day when you didn’t use your cane. The insurance company will likely consider the video footage as evidence that you claim is fraudulent and terminate your claim.
5. Telephone Calls from the Insurance Carrier. Do you truly believe your claims adjuster wants to check on how you’re doing when he or she calls you? If so, it’s probably wishful thinking. Claim specialists are calling to have an extended telephone conversation with you, after which ever word you say (all of which is likely recorded) will be examined with a proverbial magnifying glass in order to find statements to use against you (even if that requires taking things out of context). If you are not represented by counsel, the frequency of these calls can be astounding. And each telephone conference presents a chance that you will “slip up” and say something that is damaging to your claim.
6. Letters to Doctors. Has your treating physician received letters from the insurance carrier asking him/her to clarify his/her opinions or asking whether he/she disagrees with certain discreet statements? If so, your carrier is likely attempting to take a notation in a medical record or statement by your doctor out of context; and the carrier will use that statement/comment/opinion against you.
7. Letters to You Asking About Activities or Rehabilitation Plans. This one may seem obvious. If a disability insurance carrier is concerning itself with your daily activities or whether you can begin rehabilitation into the work force, there is likely an underlying skepticism regarding your inability to return to work.
8. Request for Financial Information, Especially Tax Returns. When insurance carriers request financial information, they are often trying to find out whether claimants are earning funds from other sources. They will investigate each of these sources to find any “fact” that may show the claimant is capable of returning to work or, at a minimum, use the information to reduce a claimant’s monthly benefits. If you have received a request for financial information, the carrier is examining your claim.
9. Any Activity from Your Carrier at the 24-month Mark. It’s been reported that less than two percent of disabled claimants are still receiving benefits 24 months after the date of disability. There are a multitude of reasons for this reported statistic – far too many to discuss here. If you’ve been receiving benefits for approximately 24 months and notice any of the other signs mentioned herein, it would behoove you to speak to an insurance disability attorney at once.
10. Change in Claims Specialist/Manager. There is always a chance for increased scrutiny with a new claims specialist who is often incentivised to “find” reasons to terminate your benefits.
If your disability insurance carrier has taken any of the above actions regarding you or your claim, we advise that you contact an insurance disability attorney.