Congratulations, your long-term disability insurance company approved your claim. The coast isn’t clear, however. You must remain wary of ongoing tactics used by insurance companies to limit their liability by denying policyholders’ benefits down the road. This is particularly true if you are young, have a high-indemnity claim, or both.
Here is what you have to think about:
The 2-Year Mark
Many insurance policies change the definition of disability after 24 months. We encourage you to read your policy and see if the definition of disability in your policy changes at the 2-year mark from your “inability to perform your own occupation” to “your inability to perform any occupation for which you are reasonably fit by age, training and experience.”
If your long-term disability policy contains a change in the definition of disability, we can guarantee that your insurance company will be looking to deny your benefits at that time. Insurance companies view the 2-year mark as their one free shot to deny your claim.
We recommend that you begin to gather and marshal medical and vocational support for your inability to perform “any occupation” approximately 6 months prior to the change of the definition of disability in your long-term disability policy.
They Are Watching You.
No one expects the Spanish Inquisition but, if you are on claim, you must assume you are being watched. Insurance companies hire private investigators armed with cheap cameras to follow you around and catch you doing something inconsistent with your stated physical or mental restrictions and limitations. One of our clients who suffered from severe depression had his claim denied because he was tossing a basketball to his son and the private investigator caught him “smiling.”
If you are on claim, assume that they are watching you in any space where you do not have a reasonable expectation of privacy.
They Watched You. Now They Want to Examine You.
Surveillance of a long-term disability claimant isn’t performed in a vacuum. Secret video surveillance is but one component of a suite of claim denial tools available to a long-term disability insurance company. Chances are that if the insurance company requests that you attend an independent medical evaluation (“IME”), it already has video surveillance of you and just needs a doctor to rubber-stamp its pre-ordained decision to terminate your claim.
There are a number of steps you can take to ensure the IME process is as fair as possible.
Tell The Truth.
If an insurance company catches you in a small and inconsequential lie, its rapacious claims representatives will zero in on your claim. So, tell the truth in all responses to insurance company inquiries. Avoid the kind of prejudicial scrutiny that an immaterial fib may invite.
Watch Out for Schedule C.
Many disabled individuals have passive investments in things like rental homes and commercial real estate. Be aware, if you attempt to take tax deductions on these businesses you may be representing that you are actively participating in a business and potentially prejudice your rights to continued long-term disability benefits.
Continue Getting Appropriate Care and Treatment.
All long-term disability policies contain a provision where the insurance company is excused from paying you if you fail to continue under the care and treatment of a physician that is appropriate for you condition. So, even if your disabling condition is irreversible, continue to treat with a physician for the condition as frequently as the treating physician recommends. Also, ensure that the physician takes adequate notes that continue to support your ongoing disability.
Stay in the United States?
Many of our disabled clients choose to move to countries with lower costs of living and lower taxes. Many policies excuse the insurance company from paying you if you “reside outside of the United States.” Often, these clauses are ambiguous and may be circumvented. Read your policy carefully. If you are considering relocating to another country, discuss the potential impact on your benefits with an experienced insurance attorney.
If you have any questions related to how to prepare for the change in the definition of disability in your policy, when to expect surveillance, preparing for an insurance medical evaluation, and ongoing medical treatment required by your policy, contact us. We have the expertise and tenacity to make sure insurance companies keep their promises to policyholders like you.