High Monthly Benefit Claims Targeted by Disability Carriers

Disability insurance carriers have a proven history of targeting for termination high monthly benefit claims.

This is true for all types of disability claims, but is especially so for claims involving mental and emotional illness.One reason for this is that the carriers find it easier to challenge psychiatric disorders because there are few “objective” diagnostic tools available to “prove that the disability is real. Therefore even in the most serious of situations, such as a surgeon with severe clinical depression, and bi-polar disorder, the insurer will often deny the claim asserting that the claimant is malingering, exaggerating or simply suffering from burnout. This often occurs regardless of how strongly the claimant’s treating doctors are in their diagnosis, and regardless of the behaviors exhibited by the surgeon.

Typical tactics used by insurers in denying or terminating these types of claims include:

1. Limiting or misrepresenting information provided to doctors selected by the company to perform so-called “independent” medical examinations (IMEs) of the insured.
2. Concealing or covering up test results or other information that support the claim. 
3. Manipulating covert surveillance, such as video tapes, of the policyholder.
4. Misinterpreting information provided by the insured such as tax or business records, or billing codes used for describing work related activities.&nbsp.
5. Misrepresenting things that have occurred or conversations held with treating doctors, colleagues, or witnesses.
6. Mischaracterizing the insured’s occupational duties.
7. Not authorizing follow-up psychological testing when the initial testing reveals the need to do so.
8. Making an unreasonably low settlement offer, with the threat that the claim will be cut off if the insured doesn’t accept the low ball offer.
9. Misinterpreting the coverage provisions of its own policy.
10. Ignoring the impact of co-morbidity (where more than one condition exists).
11. Ignoring the effect of prescription drugs on the claimant’s abilities.

These are but a handful of the examples of bad faith practices used by many insurers to deny legitimate claims. There are many others. Insureds should be alert to the things many insurers will do to maximize revenue. Sadly, the billions of dollars in profits that can be realized by denying legitimate claims constitute a temptation too strong to resist.