Some claims handling tactics used by long term disability insurance companies include:

Asserting a Generic Claim Denial: Insurance carriers will often provide a “pro forma” denial letter that will attempt to shift blame to the insured by citing a failure to provide sufficient evidence establishing disability under the terms of the policy.  Despite this basis for denying the claim, the insurer will not provide specifics about the needed information or identify the documentation that is missing.  The tone of the denial might well create the impression that you only need provide a little more information and suggest that you forward diagnostic imaging tests, blood tests, medical reports, etc.  This approach is designed to lull the claimant into appealing the denial without the benefit of legal counsel.  A final denial following an appeal typically forecloses the option to present supplemental evidence even if an insured later files a lawsuit.  Therefore, the insurance company would prefer that the policyholder decide what to submit rather than an experienced long-term disability attorney who has successfully appealed many such denials.

Providing Misleading Vocational Reports: Insurance companies often deny coverage based on the assertion that the policyholder has the ability to engage in work in some capacity even one that is far removed from the insured’s employment prior to suffering injury.  In support of this position, the insurer may provide a vocational report that lists the kinds of jobs that the insured allegedly could perform.  The report might highlight your educational background, work experience, and aptitude to prove that you could work in such a job.  These reports are often misleading in the facts omitted from the report.  

Disregarding the Impact of Pain Medication: Long-term disability insurers frequently assume that an insured can return to work with the assistance of drugs to manage pain.  However, this basis for denial does not take into account the side effects of pain medications.  Powerful narcotics prescribed to alleviate pain might interfere with your ability to safely operate a motor vehicle.  If you live in an area with poor public transportation, the side effects of pain drugs might prevent you from commuting to work.  Even if you can still drive a vehicle or alternate transportation is arranged, you might be unable to engage in work because the pain medication interferes with the concentration or mental clarity needed to effectively perform your job duties.

Disputing the Restrictions Outlined by Your Physician: When your doctor examines and treats you, your physician will develop an understanding of your functional limitations.  Your physician might indicate that you cannot sit or stand for more than an hour at a time without a break or that you cannot lift more than twenty pounds.  Insurance companies often dispute these restrictions by having a doctor paid by the insurance company produce a report that disputes these limitations even though he or she has never even examined you.  This basis for denial frequently involves “cherry-picking” details in your medical records while ignoring other information and the context surrounding the carefully selected facts.  A strategy for defending against this insurance company tactic is to obtain a functional capacity evaluation.  The insured’s treating physician can refer the insured for this objective test, which is typically performed by a physical therapist.  The policyholder’s ability to bend, kneel, reach, crawl, lift, and perform other physical tasks will be evaluated.  When your physician defines your work restrictions based on this scientifically verified evaluation process, the court might well find this the most accurate means of determining your ability to work.

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].

J.P. Gonzalez-Sirgo
J.P. Gonzalez-Sirgo, P.A.
Post A Comment