Some professionals are lucky enough to have comprehensive insurance packages as part of their work benefits. Their employers may provide long-term disability benefits. Many others do not have any insurance provided by their employers.
The only support they may have if they suddenly become unable to work is potentially federal disability benefits. People with families, mortgages or their own businesses might purchase private long-term disability insurance for their own protection. Unfortunately, if they ever need to make a claim for benefits, they may end up fighting against the insurance company.
Long-term disability claims can be quite costly, and insurance companies usually want to minimize what they pay out on sizable claims. Policyholders need to be ready to counter the questionable tactics below frequently used by insurance companies to justify an otherwise inappropriate claims denial.
Biased medical evaluations
Insurance companies may pay for in-depth medical evaluations that take hours to complete. As the technical client or employer of the medical professional conducting the assessment, the insurance company may apply pressure to highlight details that raise questions about the person’s condition and downplay details that make it clear they need disability benefits.
Particularly when the insurance company requests a functional capacity evaluation or a similar test, the policyholder may want to secure a second test from an outside and therefore neutral medical professional. In the event of litigation against the insurance company, an expert witness could help but pick apart inaccurate details or contradictions within the biased medical evaluation.
Private surveillance
Insurance providers are among the largest corporate clients of major private investigation companies. They hire investigators to follow claimants for days or even weeks, looking for any type of visual anecdote that can counter the claim of a disabling medical condition.
They might take pictures of an individual with a comminuted fracture in their leg standing outside of their wheelchair temporarily while waiting for a friend to help them into a vehicle, for example. The best way to counter this tactic is to embrace personal privacy and avoid scenarios in public that could raise questions about the severity of an individual’s medical conditions. Responding effectively to pictures or videos taken out of context during a trial could also help defuse this tactic.
Frequently, those trying to push back against an unfair denial of a private long-term disability insurance policy need the support of a legal professional. Reviewing one’s medical condition, policy and an insurance company’s conduct thus far with a skilled legal team can help those with disabling medical conditions pursue the coverage that they have paid for and ultimately deserve.