Has the insurance company made undue demands for proof of disability that reach beyond the requirements your disability insurance policy?
This is a common insurance denial tactic that preys on the threat of denial if the claimant does not submit to the insurer’s demands. The disabled claimant is made to believe that if they do not comply, the insurer is right to deny the claim or discontinue benefits.
Examples of Disability Insurance Carriers Making Demands beyond Your Policy
Unreasonable Proof of Claim
Your insurance policy will have a proof of claim or proof of loss provision, where you need to supply information about your disability. The requirements vary from policy to policy, and generally request information about your impairment, limitations, earnings and occupation.
Reasonable proof of claim demands generally include:
- the date of the onset of disability
- that you are under a physician’s regular care and treatment
- documentation of your monthly income
- documentation and records of your disabling condition
- the extent of disability — what restrictions and limitations prevent you from performing the essential duties of your own occupation / regular occupation / gainful occupation (depending on your policy definitions)
- names and addresses of all treating physicians
- names and addresses of clinics and hospitals where you have received medical treatment, and attending physicians therein
- Some disability policies may ask for financial records and tax returns.
Consequently, one effective denial tactic is for the insurance company to make unreasonable or non-essential demands beyond your policy that you must meet before they will award disability benefits. Insurers bully claimants into believing they have to submit additional records in order to uphold their end of the claim.
Excessive Record Requests
Prevalent among insurance denial tactics launched against disabled professionals by their insurers is excessive record requests.
While insurance adjusters have the right to request information in a disability case, they do not have the right to make unreasonable demands of a claimant.
Excess demands for documentation can include duplicate requests for information and forms already provided by the claimant and/or the treating physician. All the insurer has to do is say that it did not receive the records submitted.
Besides being a good delay tactic, these actions increase the chances of error in the filing process. It also gives an insurer opportunity to dig further into your medical and vocational history. Their hope may be to find data that they can use against your case and support a denial.
Some insurers have a track record of wearing down the disabled person with unwarranted demands for information, before an attorney’s help is sought. The insured becomes frustrated and defeated to the point he or she abandons the claim, or accepts the insurers low ball disability buyout or settlement offer.
Complying with your insurance company’s requisition for information is a major part of a claim; but do not let the insurance company take advantage of you. The company cannot try to deny your claim by using unfair requests for documents, or making demands beyond your policy.
Common demands beyond a physician’s disability policy includes
In addition to excessive record requests, there are many other tactics that disability insurers use, such as:
- Demands for “Objective Medical Evidence” as proof of claim, when the policy language does not require it;
- The insurer wrongly classifies a condition — such as Complex Regional Pain Syndrome, Fibromyalgia, PTSD or Chronic Fatigue Syndrome — as a mental or nervous disorder. They can then deny or terminate benefits under the policy’s 12 or 24 month provision for mental impairments.
- Any other requirements that appear nowhere in your disability policy — The insurer is essentially imposing fictional policy terms. This can include attempts to control your terms of care and medical treatment.
Excessive Demands beyond Your Policy become Bad Faith Insurance Claims Handling Practices
Unreasonable and burdensome demands for information outside of a policy’s provisions can be used to turn up information that can be used against you by the insurance company.
Denying legitimate disability benefits based on the selective interpretation of a policy’s proof of claim provision, or based on demands beyond the policy is breach of contract. By shifting from valid contractual requirements to inventing new terms, the camel’s nose is now under the tent and exploring ways to support claim denial.
Contact Our Disability Income Insurance Lawyers
Our long term disability attorneys represent individuals in bad faith disability insurance claims across the United States. Please contact our firm without delay if you are experiencing wrongful actions on the part of your insurance company, including delays and denial tactics to avoid paying the benefits you deserve.