Insurance companies are run to make a profit. To them, having to pay long term disability benefits to a policyholder who’s become too ill or injured to work is a loss. To avoid a loss, the insurance company will often go to great lengths to show the policyholder is not disabled and can work, even spying on them while at home or out in public. They’ll clutch at any straw — even quoting the unsubstantiated gossip of friends, family or neighbors — as an excuse to avoid their responsibilities to their policyholders.
If an insurance company has relied on questionable evidence to unfairly deny your claim for LTD benefits, you have a right to appeal. The disability insurance lawyers at Marc Whitehead & Associates have been helping clients all over the U.S. obtain the disability benefits they deserve since 1992. We’re wise to all the aggressive tactics the insurance companies employ in their attempts to discourage disabled individuals from seeking benefits. Will your insurance company talk to friends and neighbors to discredit your claim and engage in other shady practices? Possibly. But we’ve found that in many instances, their “proof” can be easily debunked by an experienced disability insurance lawyer.
Interviews and Hearsay Evidence: Refuting Testimony When the Insurance Company Talks to Friends and Neighbors
One of the insurance companies’ favorite tricks is to try and gather discrediting information through interviews with employers, co-workers, friends, families and neighbors. The interviewees are often led to believe they are helping the claimant, when in fact the insurance company agent is actually trying to gather evidence to deny the claim.
This recently happened to one of our clients, a former mortgage loan officer at University Federal Credit Union. She suffered from many disabling conditions, including mixed connective tissue disease, SI joint dysfunction, SI and hip hypermobility, spine and hip injuries, numbness and pain in low back, restless legs, anxiety, depression, chronic fatigue, migraines, musculoskeletal and connective tissue illness. She underwent back and hip surgery and needed a hip replacement. This surgery left our client unable to sit or walk for long periods of time, and the bone on bone pain caused by her conditions made it hard for her to focus.
Her insurance company, Sun Life/Ameritas, denied her claim.
One of the reasons our client’s claim was denied was that insurance company surveillance showed her performing certain activities she says she can’t perform. Their evidence included testimony from neighbors who said our client went running in the mornings. However, the insurance company was unable to provide any proof, such as photos or video footage of our client running, so we were able to have this evidence dismissed as hearsay and got her claim approved on appeal.
Other Tactics Insurance Companies Use to Deny or Terminate Benefits
Some of the other arguments an insurance company will use to deny or terminate benefits include:
- You were caught on video surveillance driving to and walking around the grocery store, therefore you are able to do more physical activities than you reported.
- Your disability is based upon a pre-existing condition.
- You weren’t eligible for coverage at the time the disability occurred.
- You are not “disabled” according to the policy definition of “disabled.”
- Your disabling condition — such as restless leg syndrome, chronic fatigue, or anxiety — is not based on objective medical evidence, but is “self-reported” and “subjective.”
- Your disability is only covered for 24 months because it is a “mental/nervous” condition.
- Your injury is “work-related” and should be handled through a Workers’ Compensation claim.
They may also require you to be examined by an insurance company doctor.
In the insurance company’s defense, they are totally within their rights to take appropriate measures to prevent fraudulent claims. The problem is when they use these tactics not to prevent fraud but to deny a legitimate claim for disability benefits.
Our advice is to follow your doctor’s orders to the letter and refrain from discussing your case with anyone — especially on social media — except your attorney.
Don’t Let Bogus Evidence Derail Your Disability Claim
If your claim for disability benefits has been denied due to questionable tactics such as requiring special examinations with insurance company physicians or evidence gathered through interviews or surveillance, we urge you to contact the long term disability insurance claims attorneyes at Marc Whitehead & Associates without delay. We would like to meet with you, review your case, answer any questions you may have and provide helpful advice on your legal options moving forward.
If we decide to represent your case, we’ll work closely with your doctors and other healthcare providers to build the strongest case possible to ensure a favorable outcome.