Dealing with chronic illness can leave you at your most vulnerable. While you spend most days practicing self-care, seeking new ways to feel better, dealing with grueling symptoms, and visiting doctors, your insurance company could be looking for ways to deny your claim or terminate your long term disability benefits. Without question, focusing on recovery, health, and wellness is a priority.  However, it is also important to understand how to advocate for your insurance benefits, and to recognize the signs of an insurer trying to take advantage of your circumstances.

How will you know if your insurer is looking for ways to terminate your long term disability benefits?

Your insurance company will likely begin with an investigation of your claim. They might inform you in writing of a “review” or “ongoing investigation” – or they might not inform you at all! Either way, you can prepare yourself.  First, you must understand the various methods used by insurers to investigate claims:

  1. Background Checks: be prepared for your insurance company to conduct a background investigation. This could include interviews with your neighbors, obtaining copies of your employment records, or even obtaining records of your social security claim or worker’s compensation claim. All of the information obtained will likely be used against you, and against your claim. Unfortunately, there is little you can do about this investigation as you are obligated to cooperate. However, you should know that limits do exist within the scope of the investigation, and you should not be experiencing harassment or an invasion of your privacy.
  2. Medical Examinations: most policies allow the claims administrator to conduct and “independent medical examination (IME).” As we have explained before, these types of examinations are anything but independent. If you find that your plan requires you to participate in an IME, there are a few things that you can do. First, notify your claims administrator (in writing) that you plan to audio record the examination. This will help you be sure that your discussion is recorded and interpreted accurately. Second, request that the claims administrator prepare the retained doctor of your intentions to record- and confirm this before your appointment. If your request is denied, be sure to confirm in writing to the claims administrator, and document the conversations during your visit with the doctor (send this in writing to the claims administrator).
  3. Surveillance: Be aware that surveillance techniques can be utilized at ANY TIME by your claims administrator…even after benefits have been approved! This means you could be recorded while out in public, taking out the trash in your front yard, grocery shopping, or getting into your car. And don’t forget about social media! If you post it on Facebook/Twitter/Instagram, it could become a part of your investigation. Unfortunately, what insurers don’t capture in their surveillance is how long you it took you to feel well enough to take out the trash, how much recovery time you needed after a simple trip to the grocery store, or the endless pain you felt (but hid) during that picture taken during a family gathering. While these might seem like very simple activities to you, your insurance company will try to use this evidence to prove that you are not disabled.
  4. Telephonic or in-person interview: Your claims administrator might request that you participate in a telephonic or in- person interview. Again, this is another tactic the insurer will use to slant information to their advantage. Remember that you always have the right to record the interview by audio or video tape. If the claims administrator declines this request…confirm the refusal in writing! Offer to submit to a written interview, where you can respond in writing to any questions from your insurance company.

If you experience or suspect any of these investigative tactics, chances are your long term disability insurer is looking for a way to terminate your benefits. Do not be intimidated, and do not give up!

We understand that an insurance denial or a termination of benefits can create added pressure, aggravate symptoms from your illness, and escalate financial stress (finances that are likely already limited funds). Insurance companies can make life very difficult, but it is important to be persistent, and fight back. Stay strong, and prepare yourself to advocate for the benefits to which you are entitled. If you have any questions, please do not hesitate to contact us for a no-cost consultation.

We understand, and we can help. (800) 446-7529