Today’s video talks about how disability insurers can use allegations of non-compliance in disability claims as a way to deny benefits. Possibly the most common forms of “non-compliance” favored by insurers is when you choose to not follow your doctor’s advice.
Fearing serious side effects, or lacking the money to handle large medical expense, you might be justified in refusing to take prescribed medications, or deciding to not undergo recommended surgeries or treatments. But it is a sure bet the insurance company will do all they can to turn your decision against you as a way to dismiss your claim on the basis of non-compliance.
There are other ways for insurers to allege that you fail to comply with your policy. Complex policy wording can confuse the unwary claimant. Required steps in the claims filing or appeals process that you need to comply with may not be clearly laid out. For example,
- The disability insurance company can instruct you to submit to an independent medical exam or a functional capacity exam (FCE) with their in-house or contracted examiners. Refusing to adhere to the insurer’s request as required by your policy may support the insurer’s allegations of non-compliance.
- If you are filing for benefits, part of the requirements of the policy may be that you must be under the regular care of a physician that is appropriate for the disabling condition. If you don’t have a specialist treating you on a routine basis, the insurance company may attempt to find it to be a matter of non-compliance with your policy and not award benefits.
- If you are currently receiving disability benefits, your insurance companies will continue to monitor your case. If you are no longer under the regular care of a physician, continuation of benefits may be dependent upon you receiving “appropriate care” or “appropriate medical treatment.” If policy language requires this, your insurer may terminate benefits.
- Understanding the period of time in which to file a lawsuit. Misunderstanding the statute of limitations as stated in your policy may be construed as a failure to comply with policy provisions;
- Filing a lawsuit past the time permitted by the policy. Misunderstanding the statute of limitations during which a lawsuit may be filed, as stated in your policy, may be construed as a failure to comply with policy provisions. If this deadline is missed, you forever lose your right to bring a lawsuit against the insurer. Unfortunately for the unwary claimant, these deadlines are not easy to understand, and many claimants lose their benefits in this manner.
Can I Stop Allegations of Non-compliance from Happening?
There are definite steps you can take to prepare yourself early in your claim, before the clock starts ticking on your ability to file a solid initial application for LTD benefits, appeal a denied claim, or seek to litigate your case against your insurance company in court.
First, no insurance company or doctor can force you to undergo surgery or treatments that are medically dangerous. Sometimes the risks do outweigh the rewards, and that can go either way. If you choose not to endure surgeries, or take specific medications for fear that they will cause harmful or lasting side effects, voice your fears with your doctor. Ask for alternative solutions. In many cases, we help our clients prepare valid arguments supported against these allegations of non-compliance.
Second, whether you are seeking disability benefits or are already on claim, do not allow treatment to end, or let gaps in treatment occur. Not even if your medical specialists releases you from their care, saying there is nothing more they can do. Often being seen only by your primary care doctor is not adequate in these cases. We can ensure you are under the care of a physician or specialist that is appropriately qualified for the condition for which you are claiming disability, and avoid allegations of non-compliance regarding appropriate medical care.
Finally, every claimant must read and understand their disability insurance policy, and know what is expected of them. This is no easy task when you are suffering from a debilitating injury or illness.
We encourage that you find a disability lawyer with experience in ERISA disability law and private disability law, who will take the time to review your case thoroughly and explain to you your options and case merit.
At Marc Whitehead & Associates, we are dedicated to assisting long term disability claimants in their fight to obtain their rightful benefits.