TOP TIPS FOR AVOIDING TROUBLE WITH YOUR CLAIM FOR SHORT AND/OR LONG TERM DISABILITY

Posted By Mark E. Hancock || 1-Jul-2022

TOP TIPS FOR AVOIDING TROUBLE WITH YOUR CLAIM FOR SHORT AND/OR LONG-TERM DISABILITY

One of the things we love doing at the Law Offices of Mark E. Hancock is helping disabled people obtain the short term and long term benefits they deserve and paid for and/or earned through the hard work they put in before becoming disabled.  We have successfully helped people recover benefits under short term and long-term disability policies for over a decade.   

During that time, we have seen how disability insurance companies fight claims and the things they do to try to avoid paying benefits.  We have successfully battled to overcome these things, but we think, it would be helpful to highlight some of them for you.  The point is not to help anyone make a bogus claim, but to help you and the lawyer you hire (hopefully us) avoid having to explain things.

  1. “DISABILITY” ISN’T JUST A MEDICAL ISSUE

Proving disability usually requires more than just establishing that you were injured and/or have and suffer from one or more medical conditions It also means demonstrating that the injury or sickness prevents you from performing (depending on your policy or plan) either your own, or “any” other occupation.  Doing this generally involves both medical and vocational evidence.

Many people only address the medical issues.  Having your doctor write a letter that says “Ms. X is disabled” is not making your case very well.  This may lessen your chances of recovering benefits.  We know and send our clients to good vocational consultants when appropriate.   We also add other forms of evidence when we can.       

  1. INSURERS SOMETIMES ASK FOR MORE THAN THEY ARE ENTITLED TO

To those of us that deal with insurance companies on a regular basis, it’s no secret that they often like to look at everything they can get their hands on.  Sometimes they ask for more than they are entitled to.  Their requests often come in the form of requests for authorizations that they want you to sign and return.

They do this for several reasons.  One reason is to scour through all of your records for things that they might use against you and your claim.   They might deny that another reason is to make you feel uncomfortable, but is the discomfort just a coincidence?  

You always have the right to have an attorney review things like authorizations before you have to respond to them to see if they are appropriate.   When we are consulted about authorizations and requests, we always read your policy, determine whether the matter is governed by state law or ERISA and ascertain what privileges and laws may apply.  We have helped Clients successfully resist improper requests.  

  1. DISABILITY INSURERS USE SURVEILLANCE

Determinations on whether you can perform your own, or another occupation often involve explorations into what you can and cannot do, like how long you can sit, stand or walk, whether and how much you can lift and/or carry and how far you can drive and comparing your current (in)abilities and restrictions to the duties and demands of the occupation(s) at issue. 

You should be aware that the ball game is not just what is stated on paper.  Insurance companies routinely hire investigators to do surveillance and they will video you.  They may, for example, drive to your home in the early a.m., see if and when you come out and then follow you around to see where you go and what you do.  The idea is to show you doing things that you are supposedly unable to do and/or doing those things longer than your doctors or therapist said you could.

You should be aware that something as innocent as sitting with a friend for lunch, sitting at the beach, carrying a grocery basket, standing watching an outdoor concert, or using your hands in an art class might be videotaped and timed.  One time, the insurance company even tried to make something of a person driving to a couple of different office buildings and going inside for extended periods, which we countered by showing that those short trips were to the offices of her treating doctors, with whom she treated regularly. 

People do have to treat,but forewarned is forearmed and might save you grief.  

  1. AVOID SOCIAL MEDIA AND TRIPS

Insurance companies often have employees or contractors scour the internet looking for stuff that might damage your claims and case.  While disabled doesn’t mean dead, you should realize that posts and comments about things like trips, or photos of you on one, may not come across too well to an adjuster sitting in a cubicle, or to a hard-working judge in court all day. We have successfully dealt with such things, by for example, showing, in one case, that the beach photos predated the disability and, in another, that the claimant didn’t handle her own luggage, only visited friends in their home and they did the driving.

If you don’t post to begin with, you also can’t be accused of spoliation (destruction) of evidence.

  1. THE RECORD CLOSES WHEN THE INSURANCE COMPANY DECIDES YOUR APPEAL

If your policy or plan is governed by ERISA, they have to give you the right to appeal a denial or termination of benefits.  Something people often don’t know is that their ability to introduce evidence and to make a record ends when the appeal is decided.

If you do the appeal yourself and you lose it, because your appeal was not as good as it could have been, you may hurt your chances in a lawsuit and also made it more difficult to find a lawyer to help you with one, because he or she may not be able to introduce new evidence after the appeal is decided.

Accordingly, it is a better idea to hire the lawyer early on, at least promptly upon receiving the notice that the insurance company is denying your claim or terminating your benefits. It takes about as much time as they give you to do the things that need to be done to prepare and submit a good appeal.

We have prepared many winning appeals for Clients. We have successfully appealed and reversed both denials of benefits and terminations of benefits and won appeals at both the own occupation and any occupation stages.  A successful appeal means no lawsuit is necessary.  

  1. YOU ARE ENTITLED TO RETAIN A LAWYER ANYTIME AND FOR MORE THAN JUST THE APPEAL AND/OR LAWSUIT

We have helped Clients with other things besides appeals and lawsuits.  To avoid problems, Clients hire us to first review and then send in the forms the insurance companies ask them and their doctors to fill out.  Clients hire us to evaluate and oppose improper record requests.  We have helped Clients evaluate, negotiate and respond to offset and overpayment of benefit claims and to offers of lump sum buyouts.  We have been at this long enough that we have seen and helped many Clients receive their benefits through the full period of their entitlement to them.    

Call our office at (805) 642-2224 to discuss your short or long-term disability matter and see if we can help you.

Categories: Disability