Avoiding Discontinuation of Disability Benefits Under a Long-Term Disability Policy

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

If you are receiving long term disability benefits from your insurer because you have suffered a disabling injury or illness, the benefits can provide the financial support that you need to pay your bills and maintain your family’s standard of living.  Recipients of proceeds from a long-term disability policy should have a basic understanding of how disability insurance carriers function.  The insurance company has actuaries that carefully analyze the probability of you experiencing a disability and establish your premium based on this probability.  This careful calculation of the odds means that premiums are set across a large number of policies at a level where the insurer will generate a profit that can be invested to yield a return that creates additional profits.  If the insurer can avoid paying valid claims or pay less than the actual value of the claims, this significantly increases the insurer’s profits.

Even if your insurance carrier begins paying disability benefits, the insurer will still investigate to develop evidence supporting the discontinuation of benefits based on the insurer’s profit model.  

Tactics Used by Insurers to Terminate Disability Insurance Benefits

While the list of strategies used by insurance companies to stop paying disability insurance benefits is lengthy, we have provided a few common examples:

Surveillance of an Insured

The insurance company often hires a private investigator to conduct video surveillance of disability insurance claimants.  Prior to the investigator initiating surveillance, an insured is required to complete a questionnaire that asks about all of an insured’s daily activities.  The activity observed during the video surveillance will be compared with the answers on the questionnaire.  If the activities do not precisely match, the insurer will attempt to use the discrepancy against the insured.

The tactics used by the insurance investigator can be even more devious.  If you must attend a doctor’s appointment, you can presume that you are being watched during the entire trip to and from the appointment.  The insurer might even set up an appointment for an “independent” medical evaluation.  The appointment will be scheduled shortly before the lunch hour with the hope you will elect to shop or visit a restaurant on the way home.  Evidence of you struggling with an armful of packages or loading the car after grocery shopping can be awkward if your disability is a severe back injury.  While this so-called “evidence” should mean little because everyone has good days and bad days, the insurer will exploit such footage in an attempt to discontinue disability payments.

Burying Claimants in an Unending Wave of Paperwork

The insurer’s claims representative will bury you in requests for documentation regarding your disability insurance claim for the purported purpose of “updating” your file.  The document requests have a far more nefarious purpose.  The insurer has determined that your benefits might be terminated, so the insurer is going to meticulously review the documents you provide to find a basis for denying further benefits.  Frequently, a nurse reviewer will prepare a summary of all of the medical records, so an “independent” medical consultant can analyze the records to develop a medical justification for your return to work.

Field Interviews (aka In-Home Interviews)

An investigator who is hired under contract by the insurance company will contact you and request to meet with you.  The individual who contacts you will be an experienced disability insurance claims investigator.  While she might make it sound like she was in the area, this representation is likely not true.  The goal of attempting to arrange a meeting on short notice in your home is to catch you off-guard, so you make a critical mistake.  Policyholders are under no obligation to agree to this type of impromptu meeting, and they have nothing to gain by doing so.  The insured should insist such a meeting occur at the office of the investigator.

You can reach Miami Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

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