Let Seltzer Legal Handle and Maintain Your Long-Term Disability Insurance Claim

You submitted your claim forms and medical records documenting your disability. Your disability insurance company found you are disabled under the definition in your long-term disability insurance policy. Now what? If you contact Philadelphia long term disability lawyer from Seltzer & Associates we can take the guesswork of out of your claim.  

Continued Proof of Loss

You were required to provide the disability insurance company proof of loss during the initial submission of your claim for disability benefits. Now you are required to continue to submit updated information. All long-term disability insurance policies contain provisions which place the burden of proving disability on you, not the disability insurance company. The disability insurance company will continuously evaluate your claim to determine if you continue to satisfy the definition of disability under the terms of your policy. They will request from you and review updated information regarding your claim. One of the biggest misunderstandings claimants have is to assume that once your disability insurance company accepts liability, it will continue to accept liability and pay your claim to the end of your benefit period. This is not the case. These policies are unique in how they work. Proof of loss is required every single month you request disability benefits be paid. Your company has the right to terminate your claim whenever, in their opinion, you have not satisfied proof of loss.

How Will My Claim Be Reviewed by the Insurance Company?

The disability insurance company has a number of ways to continually review your claim. They will use the following methods:

Attending Physician’s Statements for Long-Term Disability

All long-term disability insurance policies require you to provide proof of loss at the onset of your claim and throughout your period of disability. One of the components of proof of loss is the attending physician’s statement (“APS”). All disability insurance companies require your treating physician to complete their APS form on a regular basis. While each long-term disability insurance company has its own unique APS form, they generally all follow the same pattern and request similar information and opinions.

On an APS, your physician will generally be asked to identify your primary medical condition and any secondary medical conditions which are “disabling” to you. Then your physician will be asked to identify any restrictions and limitations which arise from your conditions. Oftentimes, treating physicians do not understand what restrictions and limitations mean within the world of disability insurance. Nor do treating physicians understand how such restrictions and limitations apply to your specific occupation and the definitions of total and/or residual disability as it applies in your policy.

If the APS is not filled out properly, with all pertinent medical information and opinions, it can be used to establish a basis in the position of your disability insurance company to challenge your claim with adverse consequences, including causing your claim to be denied or terminated.

At Seltzer & Associates, a Philadelphia long term disability insurance attorney will work with your physician to make sure they understand what information your disability insurance company requires, which will be reviewed by its team of forensically trained physicians to determine whether or not they are of the opinion that you are disabled. We make sure your physician understands what restrictions and limitations mean, how disability is defined in your policy, and what specific information the company needs to assess and evaluate whether it has liability in any claim. This allows your treating physician to provide a complete and accurate medical opinion as to the nature of your disabling condition and the impact it has on you occupationally and in life. 

Our Philadelphia Long Term Disability Insurance Attorneys Will Help with the Claimant’s Individual Statements

All long-term disability insurance policies require you to provide proof of loss at the onset of your claim and throughout your period of disability. One of the components of proof of loss is the claimant’s individual statement form. All disability insurance companies require you to complete their claimant’s statement form on a regular basis. While each long-term disability insurance company has its own unique form, they generally all follow the same pattern.

The claimant statement forms are generally going to ask for some background information about you, your disability, including your treatment history and medications, and your work activity. The questions will be specific but only provide a small amount of space for your answer. Often times, the questions can be confusing or feel like they do not provide you with ample opportunity to describe your situation. It is important to provide all of the relevant information regarding your medical condition and work activity to the disability insurance company.

At Seltzer & Associates, we will work with you to provide all of the necessary information to your disability insurance company. It is important to remember the company will use your answers to compare with the answers your doctor provides on the attending physician statement and all of the other information they gather. Your disability insurance company will scrutinize your answers and look for any inconsistencies they can find in the information they have been provided. Your Philadelphia long-term disability attorney will work with you to compile all of the necessary information to provide the company so they have a complete and accurate understanding of the nature of your disabling condition and the impact it has on you occupationally and in life.

Functional Capacity Evaluations

Nearly all long-term disability insurance policies allow the insurer to have you examined and/or evaluated throughout the course of your claim for disability benefits. One of the ways you may be evaluated is through a functional capacity evaluation (“FCE”). Alternatively, your treating doctor may request you undergo a FCE to confirm or rule out specific diagnosis with relation to your medical condition, or to better understand your medical condition.

Functional capacity evaluations are physical evaluations designed to determine your ability to function, for purposes of your disability claim in a work setting. These evaluations can last from one to several days and use “objective” testing and observation to determine your ability to lift, push and pull weight, stand, walk, grasp, hold, and reach, and bend and balance. They may be structured to test gross physical functionality or “fine” manual dexterity, depending on the need or situation. FCEs are often used when you have been out of work to determine if you are able to return to work or if your physical condition continues to prevent, limit, or restrict your ability to work. FCEs may also be helpful when you are suffering from subjective symptoms such as fatigue or fibromyalgia.

Independent Medical Examinations

Insurance companies often require you to attend Independent Medical Examinations as part of the continuing proof of loss you are required to provide. These “independent” exams take place with a doctor the insurance company has selected and paid to evaluate you. Most policies have specific language requiring you to attend these IME’s when requested by your company as a requirement to be eligible for benefits.

It is important to remember the process is not always objective and the doctor examining you may not be truly independent. These IMEs do not favor you. You must understand your insurance company may place you under surveillance in the days before or after your IME. It is looking for any inconsistencies between activities you are observed performing and the findings of the IME doctor. Remember the IME doctor is not treating you, they are examining you on behalf of the insurance company, and doctor-patient confidentiality does not exist.

In addition to a traditional IME, where the doctor is performing a physical examination on you, the insurance company may require you to attend an IME that includes neuropsychological testing. This testing is used to objectively evaluate your cognitive symptoms, such as memory, focus, and concentration. If you suffer from any psychological medical condition, the company will almost certainly request you undergo neuropsychological testing.

Vocational Assessments

Vocational assessments are an important tool in determining what, if any, work you are able to perform. Vocational assessments determine what your occupation was before suffering your disabling medical condition and the important duties it required. By reviewing your medical records, a vocational consultant will determine if you are able to perform all, some, or none of the important duties of your occupation. Additionally, a vocational consultant can perform a Transferable Skills Analysis. This analysis is an evaluation of the skill, education and training you poses, along with the possible education and training you can receive to determine what, if any, other occupations you may be capable of performing.

It is important to understand 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.

Surveillance & Investigations

Most disability insurance companies will likely conduct video surveillance of you as part of the investigation of your claim. They will use this video surveillance of you once you are on claim to warrant a termination of your disability benefits. While you may be under surveillance around the time of an Independent Medical Examination, companies can and will perform surveillance whenever they want during your claim. Often times, this surveillance is unreliable and misleading. However, your insurance company will use the video information obtained to show alleged inconsistencies with the information you and your doctors are providing in order to discredit and challenge your claim.

Your disability company will also investigate all information about you that is available online in commercial databases and social media sites. The company will be looking for alleged inconsistencies with the information that has been provided to them in order to attack your claim.

Field Representative Meetings

During the course of a claim or the claims process, it is extremely common for the company to request what is referred to as a “field representative meeting.” This meeting is one of the most, if not the most, an important part of your entire claim. This is an opportunity for the company to see you in person and to “size you up” as to how you present yourself, whether or not you appear to be in pain, for example, to assess your credibility and believably, and how you will appear on a witness stand, in addition to what you will be saying. It is also common for the company to have or have had a surveillance workup at the same approximate time as the field representative meeting.

A field representative is essentially an outside investigator, conducting an investigation of your claim on behalf of your disability insurance company. The field representative will be experienced, forensically trained, and have set “marching orders” from the company in the form of oftentimes scripted questions that the claims department wants answered. The field representative will be familiar with your claim and will have reviewed either the actual file or summaries of your claim and pertinent issues prepared by the claims department.

Essentially, the company has the field representative meeting to acquire updated information on your claim. However, it is oftentimes and most usually, an opportunity for the company to develop information essentially to refute or challenge your claim.

If you are not fully prepared for this component of the process, you have made yourself extremely vulnerable and more prone to having your claim defeated. Sometimes, at the conclusion of the field representative meeting, the representative may even ask for your signature, in the form of a signed statement, which can be extremely problematic.

Let Seltzer & Associates Take the Guesswork Out of Your Claim Long Term Disability Benefits 

At our law firm, we will protect your interests in every aspect and component of the claims process, including the field representative meeting. We give our clients an education about this process and what to expect, and properly prepare our clients accordingly. Our Philadelphia long term disability lawyers make sure that this meeting goes in the most positive way for our clients so that your disability insurance company will understand the severity of your medical condition, how it negatively impacts your ability to perform the important duties of your occupation, and to help the company have a much better and fuller understanding of why you are entitled to benefits under your policy.

These are just some of the methods the company will use to review your claim. It is essential you cooperate with each of the methods and comply with the provisions in your policy. We will protect your interests and assist you with this cooperation by communicating with the disability insurance company on your behalf and making sure all relevant information is provided in full in the strongest way.

Contact Seltzer & Associates today and allow our team to assist you with your long-term disability insurance claim.