When you file a claim for disability, you will most likely have to undergo a functional capacity evaluation, or FCE. This evaluation is a series of tests that are designed to see how you perform at specific tasks related to your job. Why is this evaluation so important for those claiming disability?
Category: Disability Insurance Claims
What are a Forensic Psychiatric Experts and How Can They Effect Your Claim for Long Term Disability Insurance Benefits?
Last time, we talked about how courts were starting to view the findings of treating physicians less favorably due to independent medical evaluations conducted by insurers and “reviewing” physicians calling their opinions into question. This, however, isn’t the only reason why your doctor’s medical opinion may not be given as much weight as one from someone who has never seen you before: quite simply put, the job of a treating physician is a lot different from that of a forensic psychiatric expert, or FPE.
Treating Docs May Hurt Your Long Term Disability Insurance Claim
As far as most people are concerned, when their doctor tells them something their word is final. After all, they have years of medical training and know what they’re talking about. So if your doctor tells you that you suffer from a disability and should be able to receive long term disability benefits, then that is the end of the argument, right? Wrong.
Insurers have been pitting doctors against each other for years by asking claimants to have an independent medical evaluation with a physician that they choose. Supposedly, the idea is just to get a second opinion and see if another medical professional will objectively agree or disagree with the original findings. More and more, though, these independent examiners end up “reviewing” the work of the treating physician and searching for ways to call it into question.
Long Term Disability Insurance Claims: How Insurers Fight The NAIC Model Act
Last time, we talked in-depth about the 2004 NAIC Model Act, which was created as a way to ban discretionary clauses from health and long term disability insurance policies. As we noted, these clauses help insurance providers to deny claims to people that otherwise appear to be covered under the policy. More than half the states in our country have acknowledged the unfairness of discretionary clauses and enacted either a version of the NAIC Model Act or another ban to do away with them, but insurers still attempt to get around these bans.
Long Term Disability Insurance: What is the NAIC Model Act?
Recently we’ve dealt a lot with how “discretionary authority” is sometimes used in insurance plans to allow the insurer to deny a claim that might otherwise appear valid and how this can impact your case if you need to go to court to get the benefits that you deserve.
The standard that the court uses to review your case depends on what state you live in and that standard can go a long way towards determining whether you’ll ultimately win or lose your case. Claimants in states following an “arbitrary and capricious” standard of review only win 28% of the time, while those in states using the “abuse of discretion” standard win far more often – in 68% of ERISA disability lawsuits.
What are Deferential Standards and How Do They Affect Your Long Term Disability Insurance Claim?
No one wants to have their claim denied, but when it happens you have to be prepared to fight to get the benefits that you know you deserve. Part of being prepared is knowing what standard of review you are likely to face.
Recently, we talked about how you can know whether you’ll face the more favorable de novo review or a deferential review that gives the advantage to your insurer. But there’s a question that may be even more important: if it is determined that the court in your case will be using a deferential standard of review, you need to know if that standard will be abuse of discretion or arbitrary and capricious.
What is a Long Term Disability Insurance De Novo or Deferential Review?
Recently, we went over the various kinds of standards of review you can expect for your disability claim if you are denied and have to fight the decision in court. There’s what is known as de novo review, where the court agrees to act as if the insurance company’s original decision never occurred and approach the disability evidence without bias. And then there’s deferential review, where the court gives a varying amount of weight to the insurer’s decision depending on whether their standard of review is arbitrary and capricious or abuse of discretion.
Generally speaking, both standards put the claimant at a disadvantage because the court is essentially assuming that the insurer is right until proven wrong. Unfortunately, claimants can’t just choose the standard of review that they want to use.
What is the Standard of Review for Disability Insurance Claims?
When someone has their long term disability insurance claim denied by their insurance company and decides to fight that decision, the court must use a specific set of criteria to determine whether or not the insurer made the right call. These criteria are called a “standard of review.” Depending on the parties involved and the specific situation, the court may decide to use a standard of review that includes a lot of deference toward the original decision that was made… or one that reviews the information as if that initial decision never occurred.
Insurance claims tend to fall under one of three types of standards: arbitrary and capricious, abuse of discretion, and de novo.
Long Term Disability: Still Health Insured After Losing Job?
It’s everyone’s nightmare: something happens to you that necessitates you going on disability through your insurer, then you get fired from your job and your insurance is terminated. What’s going to happen to you? Will you still be able to get disability benefits? Can your employer even do this?
First let’s get the question of losing the job out of the way. Disability insurance and benefits by themselves don’t come with any kind of job protection. In fact, often someone will need to prove that they aren’t able to work in order to get disability benefits. That being said, if you believe you’ve been wrongfully terminated due to your disability, you’ll want to
How Social Media Can Hurt Your Long Term Disability Insurance Claim
We live in a culture where it’s becoming more and more expected to tell the world about every single thing that you do, from “Had a blast at the baseball game tonight” to “Finally cleared all that junk out of the attic – whew!” Both of those are things you might see any one of your friends post at any given time. They are also things that you might find yourself doing if you were out of work due to a disability because of all the extra free time you have.
Unfortunately, despite the fact that neither one of those activities really does anything to disprove a disability claim, more and more insurers are delving deeply into people’s lives in an attempt to discredit claims. Even if you just want to update those friends and family members you’re not seeing because of your disability, saying the wrong thing on social media can have dire consequences.