Private Disability Claim Handling & Maintaining
Many disabled physicians and other highly skilled professionals incorrectly believe that once they receive a private disability insurance benefit claim approval, they are entitled to receive checks continuously in accordance with the terms of the policy. Nothing could be further from the truth. The disability insurance company is in business to make money, and as long as it is paying out claims, it is not making money. The company hires people whose specific job it is to review claims like yours each month and look for ways to legally discontinue paying your disability claims. It is up to you, the claimant, to prove that you continue to meet the criteria for payments under the policy terms. Rather than attempt this feat on your own, it’s best to consult with a disability insurance attorney.
Proof of Loss and Individual Statement Form
Every long-term disability insurance policy and private disability insurance policy requires the claimant to provide proof of loss when initially applying for the claim and then at regular intervals thereafter. This process includes completing an individual statement form in which you are required to provide:
- Information about your background
- Details of your disability, including treatment history and medications
- Your work activity
The company will scrutinize every word on this form, comparing your answers to physician statements and medical records as they look for inconsistencies to bolster an argument to deny disability insurance coverage.
Functional Capacity Evaluations
Under the terms of many policies, the disability insurance company can conduct a functional capacity evaluation (FCE), which is designed to determine work capacity by certain objective means, such as the ability to bend and lift objects or degrees of manual dexterity. FCEs are often used when you have been out of work to determine if your physical condition continues to prevent, limit, or restrict your ability to work. How you fare under this type of scrutiny can play a large role in whether or not your benefits continue.
Independent Medical Examinations as Part of Your Disability Insurance Claim
The Independent Medical Examinations is a common tool used by disability insurance companies to assess and evaluate the medical evidence supporting one’s claim. In theory, an Independent Medical Examination sounds like a conclusive way to further support one’s disability claim. However, these medical examinations are not “independent.” Instead, these exams are conducted by doctors selected and paid by the insurance company. Disability insurance companies often provide examining physicians with specified questions designed to challenge one’s level of medical care and the severity of their medical impairments.
While the Independent Medical Examination is a tool utilized by disability insurance companies to find ways to get out of paying your claim, there are ways to protect against biased examinations.
Vocational Assessments Can Be Challenged by a Philadelphia Private Disability Insurance Attorney
Vocational assessments are supposed to determine if you are able to perform any of the important duties of your occupation. they look into your skills, education and training, to determine what, if any, other occupations you may be capable of performing. If you have an Any Occupation policy, your insurance company will have a vocational consultant perform an assessment to determine what occupations you are able to perform.
Disability insurance companies often engage in flawed vocational assessments that minimize material aspects of one’s occupation and/or apply incorrect and outdated standards.
Surveillance & Investigations
Most disability insurance companies will conduct video surveillance of you as part of the process of trying to find ways to terminate your coverage. Even though these surveillance videos are often unreliable and misleading, your insurance company will use the video information obtained to try to show alleged inconsistencies with the information you and your doctors are providing. Your disability company will also investigate all information about you that is available online in commercial databases and social media sites.
Field Representative Meetings
During the course of a claim or the claims process, it is extremely common for the disability insurance company to request a field representative meeting so they can assess your credibility and believably, often looking to see how you might appear on a witness stand (in the event their denial of your claim is challenged in court).
How a Philadelphia Private Disability Insurance Attorney Can Help
If you are not vigilant in staying fully prepared for each component of the insurance company’s ongoing review process, you will become extremely vulnerable to having your claim defeated. As individual and long term disability attorneys, we know how to protect you throughout the ongoing claims process, making sure your disability benefits continue for as long as you need them.
Contact a Seltzer & Associates For More Information
To learn more about how we can provide monthly claim handling services, please contact our office at 888-699-4222 to speak with one of our disability insurance lawyers attorneys. Our legal team is based in Philadelphia and works with clients throughout the country.