The information you put on your long-term disability claim forms and monthly progress reports are all material representations by you to your insurance company—and must be factual!
A recent case involving a man who has been alleged by the New York State Attorney General of fraudulently obtaining $1.3 million in disability benefits from his insurance company is a dramatic example of why not to mislead or misrepresent that information.
In this case, the individual is alleged to have falsely submitted statements to his insurance company—claiming a non-working status on his form. In fact, not only had he continued to practice medicine, he did so without a license (which was apparently lost in 2007).
The man was indicted for practicing without a license and, primarily, for misrepresenting his work status and collecting $1.3 million dollars from his long-term disability insurance company for a period of four years.
Our firm represents over 300 clients in varying stages of the claims process—most of whom are getting paid. Periodically, progress reports must be submitted to the insurance company which includes information about:
•What the person is doing;
•Whether he or she is working;
•Activities he or she participates in, and more.
Often, people will just duplicate the content of the forms over a span of years; yet, in fact, activity levels, etc. may have changed. Accuracy is essential; your receipt of insurance benefits could be jeopardized due to misrepresentation on a claim form.
A sophisticated long-term disability lawyer can ensure that your forms are not misrepresenting your status, nor willfully withholding information that should be disclosed. This particular case is a cautionary tale: people must be careful and truthful with the information shared on their insurance claim forms.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack