Long-Term Disability Insurance Attorney Answers Important Questions [Part III]

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

This is the conclusion of our three-part blog post, offering answers to important questions we often receive from consumers about their long term disability insurance policy and claims issues.  Although we have attempted to respond to many of the questions our firm receives, policyholders are invited to contact us for information about their unique situation.

How should you respond if the information given to you during telephone conversations is inconsistent with the letters you have received, including the denial letter?

The recollection of an insurance company representative might differ substantially from your account of a telephone conversation, so telephonic conversations should be memorialized by follow up letters/emails.  However, claimants need to be cautious about communicating in a fashion that is inconsistent with an indicated disability.  If you are suffering from carpel tunnel, for example, lengthy letters that you write in your own hand could pose problems.  A more appropriate form of communication in this situation might be a typed letter that indicates it was typed by someone else and approved by you.  Similarly, long telephone conversations might be an ill-advised way to communicate if you are suffering from a head injury that you indicate is impacting your cognitive functioning.  While this advice might seem ludicrous because even people who are disabled have moments where they function above their normal level, the insurer is looking for ANY evidence to call into question the legitimacy of your claim.

Why are your physicians in contact with your long term disability insurance company?

The practice of seeking information, reports, and test results from medical providers is customary for insurance companies investigating a disability claim.  Because your insurance company will gather such information, you should seek treatment with physicians who support your disability claim because they can write letters that strengthen your claim.

How can your private long-term disability insurance company deny your claim when your claim was approved by Social Security?

This situation often results in long-term disability carriers engaging in conduct that represents the height of hypocrisy.  The requirements for approval of a disability claim through Social Security are less rigorous than a claim with private insurance carriers.  If your Social Security claim is approved, the insurer will apply these tougher standards and disregard the SSDI determination.  By contrast, the long-term disability carrier will be quick to reference your SSDI denial in support of its opposition to your disability claim with the carrier.  Most disability polices require an insured to file a claim for SSDI benefits and often permit the insurer to reduce the amount of the payments in proportion to the amount received from Social Security.

Why did your insurer stop making claim payments to you after two years?

The two year threshold is very significant to a long-term disability insurance claim, so carriers often stop making payments at this point even when an insured’s medical condition and prognosis have declined.  The basis for this change is that most policies change from a less demanding standard that bases disability on your ability to work in your “own occupation” to the ability to work in “any occupation” after two years.

Are you just being paranoid if you suspect that your insurance carrier has placed you under surveillance?

Unfortunately, your instincts are probably spot on.  Long-term disability insurance carriers frequently use video surveillance for a couple of reasons.  First, rumors of such surveillance can discourage claimants with legitimate claims related to severe injuries or illnesses from pursuing a valid claim.  Second, the saying that a picture is worth a thousand words is very true in the context of a disability claim.  The insurer would love to catch video of someone with a significant back injury moving boxes in the garage or bending over to pull weeds in the front yard.  This type of evidence can be powerful and misleading.  When a judge or jury sees this type of footage, they might be tempted to consider the activity inconsistent with a serious back injury.  However, the boxes might contain materials for shipping, so they are filled with packing peanuts.  Similarly, the gardening activity might have lasted for less than five minutes on a particularly good day.

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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