Last time, we went over several methods that insurance companies use to try to deny long term disability benefits to people who hold “own occupation” policies with them. We talked about misrepresentation, where insurers basically try to prove that you lied or made mistakes on your application so that they can cancel your policy – even if you’ve been paying for it for decades. We described how they’re now forcing people to provide “objective” evidence (i.e. your doctor’s expert opinion isn’t good enough; your problem needs to show up on something like an MRI test or it’s not “proven”). And we warned you about doing any kind of work outside of your primary occupation, because insurers will latch on to this and argue that they can deny your claim because you really have two occupations.
Below you’ll find several more shady tactics that they use.
Shady Insurance Tactics Against “Own Occupation” Policyholders
Redefining disability. Be careful when insurers ask you for a description of your job duties. All they’re really trying to do is get ammunition to deny your claim. If you have 10 job duties and can’t perform eight of them due to your condition, they’ll focus only on the two that you can still do and try to deny benefits because of that.
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Claiming ERISA governance. Insurance companies have not only been actively working to turn more and more of their policies into ERISA policies, but sometimes even deny benefits by claiming that a policy’s covered under ERISA when it clearly shouldn’t be. Why do this? Because they have much less liability with an ERISA claim, which means they’re practically guaranteed to pay out less money.
Requesting IMEs. What are IMEs? Insurance medical evaluations. Typically these are given to people who are already receiving benefits when the insurer wants to reevaluate their condition in the hope that it has improved and they can terminate the benefits. It seems reasonable enough – prove you still have problems to keep getting money – but insurers often stack the deck in their favor by using their own physicians.
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Conducting surveillance. Nothing gives your insurance company the right to spy on you, but that’s exactly what many of them are doing when attempting to deny a claim or terminate benefits. The idea is that they’ll “catch you in the act” and be able to prove that you’re not really disabled. But this kind of surveillance is often edited and editorialized to paint claimants in the worst possible light.
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Long term disability insurance claims obviously cost insurance companies a lot of money, but that doesn’t mean that they should be able to use tricks and subterfuge to deny your valid claim. If you believe they’re in the wrong, you owe it to yourself to fight back. Check out our free e-book for more details about ERISA disability and be sure to stay up to date on new long term disability information through our weekly blogs!
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