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High Scrutiny of Long-Term Disability Insurance Claims by Insurance Companies

High Scrutiny of Long-Term Disability Insurance Claims by Insurance Companies by Evan Schwartz

{3:30 minutes to read} Filing a claim for long-term disability benefits is an exhausting and complicated process—especially in the early stages. Professionals need to be wary of what this process entails in order to be prepared and ensure that their claim is approved.

Upon receiving a long-term disability claim, insurance companies carefully and extensively examine it before they acknowledge their liability to pay the claim. A simple medical report and claim form will not be sufficient. In today’s environment, insurance companies treat disabled professionals seeking benefits like suspects in a criminal conspiracy. I can’t overemphasize the need to consult with competent counsel, if at all possible, before filing a long-term disability claim.

Below are a few key things insurance companies do once they receive a claim.

Rescission Review

One of the first things that the insurance company will do is conduct a rescission review. The purpose of this review is to determine whether a person has made false statements regarding their income or medical history (or something similar in nature) on their application. If the insurance company believes that false statements on the application would have affected its decision to offer you the policy it sold you, it will try to rescind the policy by returning all premiums previously paid and claiming that the policy is void, as if it was never issued in the first place.

Medical Review

The insurance company will conduct a detailed medical review to determine whether or not your restrictions and limitations caused by the claimed disabling condition(s) truly render you unable to perform your job duties. The medical reviewers employed by the insurance company are highly skeptical—there is no “benefit of the doubt” help to support your claim. They may, and often do, hire an “independent” doctor to examine you and write a report to the insurance company on whether they believe you are disabled.

Therefore, the medical information submitted by you in support of your claim must be consistent with your diagnosis, or diagnoses, if more than one. The support should contain objective documentation of your disability, if at all possible, and your supporting doctors should verify that your disabling condition(s) limit or prevent you from performing your job.

Financial Review

The financial review is used to classify a person as totally, partially, or residually disabled.

Unless a person is a W-2 employee with an easily determined salary, the insurance company will review tax returns, profit and loss statements, and other financial and production reports to understand how your money is earned and spent.

Field Interview

In addition to the aforementioned reviews, the insurance company may request a field interview—a face-to-face meeting to discuss all of the issues surrounding your claim with you—prior to deciding whether to pay you benefits. Please see my previous blog on Field Interviews for further information.

Surveillance

The insurance company may conduct surveillance on you, to determine whether you may be engaging in activities which they believe are inconsistent with your claim of disability.

Companies that are known to utilize the aforementioned reviews and tactics include, but are not limited to:

•Unum;

•The Guardian and Berkshire;

•Northwestern Mutual Life;

•MassMutual Life;

•Principal Life;

•Met Life; 

•The Standard; and

•The Equitable.

Particularly in the early stages of the claims process, it is imperative to consult a sophisticated and experienced lawyer to help and protect you from the gamesmanship that will ensue before an insurance company will commit to paying ongoing, monthly disability benefits.

If you have questions about this complicated process, contact Schwartz Law today at 212-608-5445 for a free consultation.

Evan-Schwartz

 

Evan S. Schwartz
Founder of Schwartz Law
800-745-1755
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