Don’t Let Your Legitimate Claim Become Part of an Insurance Company’s Savings Plan

Erik Heninger

July 14, 2017

At some point during their working life, over 30% of women and 25% of men will have a disability that keeps them out of work for 90 days or more. Going a year or two without work can often result in financial catastrophe for an individual or family. One of the most responsible financial considerations an adult can make is to maintain disability insurance. Disability insurance can provide up to 60% of regular income when someone is unable to work due to an injury or illness.

However, less than half of American workers have any kind of disability insurance. One of the biggest reasons for this low percentage is that not all employers offer disability insurance to their employees, and if they do, only around 40% pay the entire premium. Just because a worker maintains disability insurance does not guarantee that their claim will be approved and paid. Valid disability claims are routinely denied by insurance companies when those claims do not meet the strict medical evidence requirements.

Large Insurance companies are skilled at construing policy terms or conditions in a manner that allow them to deny claims. They may misconstrue medical records, injuries or facts of the claim and events leading up to the claim. Insurance companies may also severely undervalue the injury or benefits under the policy.

The crux of these claims is that an insurance company has been receiving thousands of dollars in premiums over the years from people who are wanting to protect against being injured and not able to work. Yet, when something catastrophic occurs, the insurance companies make the process even more painful by denying claims or making their insureds jump through ridiculous hoops and hurdles to get paid under a policy that they’ve paid a lot of money to protect them.

Unum, the world’s largest provider of disability insurance, has been the defendant in several class action lawsuits and thousands of bad faith lawsuits for systemic practices dating back to the early ‘90s. In 2002, Unum lost a case in San Francisco Federal Court, costing them a $7.5 million judgment and forcing them to rectify their claims process. The court found Unum acted “in bad faith,” and used “bias medical examiners” to deny claims. In 2004, they were fined another $15 million and forced to review 200,000 previously denied claims. A 60 Minutes special elaborated on the calculated way in which the company likely weighed bad publicity and attention against savings from not paying claims.

Here are the three major areas that claims administrators justly or unjustly use to deny claims:

1.  Insufficient Medical Evidence

  • For your best chance at receiving your claim, you should be visiting the doctor regularly and your doctor should be giving you objective tests, including x-rays, MRIs, or CT scans, whenever possible.
  • Make sure you know what medical records are required by your provider.
  • Your attorney should word a request to your doctor to provide a detailed opinion to how your disability limits your work. Do not trust an insurance company form.

2.  Policy’s Definition of Disability

Some policies ask you to prove that you can’t do your current job, while others force you to prove that you can’t do any job.

Carefully read your policy to see how it considers conditions that rely on subjective complaints (depression, chronic fatigue, fibromyalgia) and pre-existing conditions.

3.  Video Surveillance That Catches You on a Good Day

The way companies perceive you often changes from friend to foe when you file a claim. Insurance companies have had investigators follow customers in an attempt to catch them doing something that contradicts their condition.

If you think you may have been unfairly denied a claim, let’s talk. Even if you feel you are not ready to file a suit, consult one of our qualified lawyers as soon as possible so that you will know your options. We do not charge any fees upfront. In fact, we will only charge attorney’s fees if we obtain a financial settlement for you. If you don’t win, we won’t get paid a legal fee. Call us today for your free case evaluation 1.800.241.9779. We can work to keep insurance companies accountable together. 

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