Obstacles to Obtaining Long-Term Disability Insurance Payments From an Insurer [Part II]

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

When you suffer a debilitating illness like cancer or a permanent injury that prevents you from working, long-term disability insurance benefits can provide a vital form of financial security for you and your loved ones.  Sadly, many policyholders who have the foresight to purchase an insurance policy and exercise the responsibility to make timely payments are disappointed when their insurer fails to uphold its side of a disability insurance contract.  This is Part 2 of a two-installment blog post discussing potential challenges to getting a long term disability insurance claim paid.  (Part 1). While we have tried to address some of the biggest issues, we invite you to contact us if you have questions about your specific situation.

The Insurance Company Is Not Going to Provide Significant Assistance.  The intake person to whom you submit your disability insurance claim will generally be extremely overworked and will have no interest in your specific situation.  The role of this insurance company employee is to process the claim and assign it to a review person who can identify a basis for denying the claim.  If you ask for help with your application or appeal, you will be given very general information that provides absolutely no guidance as to what documents or information are likely to get your claim approved.  

Beware of Your Employer’s Potential Ulterior Motives.  Many employers attempt to cut costs by weeding out older employees, who will be higher paid, while hiring younger workers who can be paid less.  When older employees are struggling with physical limitations, the employer might take actions that ultimately undermine a worker’s disability insurance claim.  The employer might offer to move the employee to a “less demanding” part-time position, for example, changing his or her “own occupation” designation under the disability insurance policy.  The calculation of the worker’s disability insurance benefits will be based on a portion of the amount earned in the part-time position prior to discontinuing work.  Further, the insurance company will have a much easier time proving that you are capable of continuing to work in a part-time position, so the insurer can deny your disability insurance claim.  This scenario permits the company to obtain a dual benefit of eliminating a higher paid position and potentially reducing its disability insurance premium.

Claim Reviewers Goading Claimants Into Filing Inadequately Supported Appeals.  Many claims reviewers are affable people who genuinely seem friendly and helpful.  However, the claim reviewer is not your friend!  This is so important it bears repeating: THE INSURANCE REVIEWER IS NOT YOUR FRIEND!  The person who reviews your claim understands that the insurance company signs his or her paycheck, which will ultimately determine the reviewer’s loyalties.  The reviewer might lull you into a false sense of security by suggesting that your claim is so strong that the denial must be a “mistake.”  This statement is designed to mislead claimants into thinking they just need another letter from the doctor or some other minor adjustment.  The reviewer might even attempt to antagonize you into writing a “poison pen” letter that includes subjective reasons you feel disabled, which will distract you from gathering and presenting relevant evidence.

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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