When you file a long-term disability claim, you expect your insurance company to provide the financial support you desperately need. After all, you’ve paid your premiums and followed the rules. Unfortunately, the reality is often far from this expectation. Insurance companies are businesses, and their goal is to protect their bottom line. This often means denying, delaying, or minimizing claims wherever possible.
Understanding the tactics insurers use can empower you to protect yourself and your rights. Here’s a look at some of the strategies insurance companies employ and why having an experienced disability lawyer on your side can make all the difference.
Misinterpreting Policy Language
One of the most common tactics insurance companies use is manipulating policy language to justify their decisions. Disability policies are filled with complicated terms and definitions that can be difficult for the average claimant to interpret. For example, many policies have specific definitions of “disability” that change over time, such as moving from “own occupation” to “any occupation” after a certain period.
Insurers may use these definitions to argue that you don’t meet their criteria for disability—even if your condition makes it impossible for you to work. Without a comprehensive understanding of your policy, it can be easy to fall victim to this tactic.
Requesting Excessive Documentation
Another way insurance companies handle disability claims is by requesting an overwhelming amount of documentation. This may include lengthy forms from your doctors, detailed medical records, and ongoing proof that your condition hasn’t improved. While it’s reasonable for an insurer to require sufficient evidence, excessive or repetitive requests can create unnecessary delays or make the process feel insurmountable.
Some insurers may also claim that the documentation you’ve submitted is incomplete or insufficient, even when it fully supports your claim. This can lead to frustration and uncertainty for claimants, who may feel that no amount of evidence will satisfy their insurer.
Conducting Surveillance
Insurers often conduct surveillance to find evidence that contradicts a claimant’s reported limitations. This can include hiring private investigators to monitor you in person, reviewing your social media profiles, or even interviewing your neighbours and coworkers.
For example, if you claim that you’re unable to perform physical activities due to chronic pain, and an investigator captures footage of you carrying groceries, the insurer may use this as grounds to deny your benefits—even if the activity was an isolated incident or took place during a “good day.” Surveillance is a common tactic, and many claimants don’t realize they’re being watched until it’s too late.
Using IMEs and Claims Reviews to Their Advantage
Insurance companies often require claimants to attend Independent Medical Examinations (IMEs) or undergo regular claims reviews. While these may seem like standard parts of the process, it’s important to understand that IMEs are not truly independent. Insurers typically hire doctors to conduct these exams, and these doctors may downplay your condition or suggest that you’re capable of returning to work.
Similarly, claims reviews are used to reassess ongoing eligibility for benefits. Insurers may identify minor improvements in your condition and exaggerate their significance, claiming that you’re no longer disabled under their definition. These reviews often work in the insurer’s favor, not yours.
Offering Low Settlements
If an insurance company recognizes that you have a strong case, they may try to resolve the matter quickly by offering a lump-sum settlement. While this can be tempting, these settlements are often far lower than the total benefits you’re entitled to. Insurers count on claimants feeling overwhelmed and desperate for relief, which can lead some to accept an offer without fully considering their rights or future needs.
Delaying Decisions
Time and financial strain are powerful pressure points for claimants. Insurance companies may take advantage of this by delaying decisions on claims or dragging out the appeals process. They hope that prolonged stress and uncertainty will cause you to give up or accept less than what you deserve.
Such delays can be particularly challenging for individuals who are already dealing with the emotional and physical toll of a disability, leaving them feeling helpless and unsupported.
How an Experienced Disability Lawyer Can Help
Facing an insurance company’s well-practiced tactics alone can feel overwhelming, but you don’t have to go through it alone. An experienced disability lawyer can level the playing field and help you protect your rights. Here’s how they can assist:
- Interpreting Policy Language: A lawyer will review your policy in detail, ensuring that you fully understand your rights and entitlements. They’ll hold the insurer accountable for the promises outlined in the policy.
- Challenging Denials: If your claim is denied, a lawyer can identify weaknesses in the insurance company’s reasoning and build a strong case to fight back.
- Dealing With Surveillance: Lawyers know how to counteract unfair surveillance evidence and ensure that isolated incidents don’t skew the overall picture of your disability.
- Handling Claims Reviews: With legal guidance, you can confidently navigate IMEs and claims reviews, avoiding pitfalls that could jeopardize your benefits.
- Negotiating Fair Settlements: If a settlement is on the table, a lawyer will assess its fairness and negotiate for an amount that reflects the full value of your claim.
- Pushing Back Against Delays: Legal representation ensures that your case moves forward without unnecessary delays, keeping the pressure on the insurance company to act in good faith.
Final Thoughts
Long-term disability insurance is meant to provide financial security during challenging times. Unfortunately, many insurance companies prioritize profits over the well-being of their policyholders. By understanding the tactics insurers use to deny, delay, or minimize claims, you can take steps to protect yourself and your benefits.
At Kotak Law, we specialize in representing claimants who have been denied long-term disability benefits. Our team is dedicated to standing up to insurance companies and fighting for the rights of our clients. Don’t face this battle alone. Contact us today for a free consultation, and take the first step toward securing the benefits you deserve.
