What are the most important issues?
A major focus of the work of Pillsbury & Levinson is the representation of policyholders who have had disability claims improperly denied. Pillsbury & Levinson is one of the most experienced firms in the country in such disability claims and disability insurance law and has represented hundreds of disabled policyholders over the past decade. From this experience, there are a number of basic rules that can be suggested to help one protect his/her disability insurance rights:
- Your disability claim may be controlled by ERISA. Know your rights -- or lack thereof -- under ERISA;
- The insurance company has many in-house medical professionals, including doctors who may be asked to review your medical records. Occasionally, in-house medical professionals are provided incentives to cherry-pick medical records, summarize records in a misleading way, or gather information which sheds doubt on a disability claim in order to deny disability claims;
- Your treating doctor is your strongest ally. The greater his/her specialty, and the more detail he or she can provide regarding your condition, the more persuasive he/she will be with your disability insurance company;
- Your disability claim form contains a very broad medical records authorization. This is much broader than it needs to be and it will be used by the insurance company to obtain any and all records it believes will help it deny your disability claim;
- Often, you do not have to produce tax returns to the insurance company even though the company often asks for them. The insurance company often requests these documents simply in order to determine if you have made inappropriate entries on your tax returns; that way, they can attempt to discredit you;
- Disability insurance companies are increasingly using surreptitious surveillance to videotape insureds in the hopes of catching them doing something on camera that they can then claim to be inconsistent with the insured's claimed restrictions;
- There are often major limitations in policies for disabilities based on mental or psychological conditions;
- Your policy may insure you against disability claim from your own occupation for only a limited period of time. After that, it may insure you only against a disability claim in which you are unable to work in "any occupation" for which you are reasonably qualified by reason of training, education, or experience. Often the insurance company will stop paying benefits once the definition of disability changes;
- If the insurance company sends you to be examined by a doctor of its choosing, in most cases you have the right to make an audio or videotape of the entire examination;
- Remember, if it is not in writing, the insurance company may claim it never happened. Be sure to document all communications you have with the insurance company representatives.
Contact us if you have further questions about disability claims or disability insurance law.
