BE CAREFUL ABOUT WHAT THE INSURANCE COMPANY TELLS YOU
In our experience, it has become apparent that there are common ways in which insurance companies handle disability claims. The following are some of the more routine statements that have been made by the insurance company to claimants and why you should challenge them.
Insurance claim denials / Be Careful with Insurance Companies
- In order to qualify for disability the medical evidence must be objective
Firstly there is a difference between subjective medical evidence and objective medical evidence. If you point to your low back and say it hurts – that is subjective; if an x-ray shows your back has a fracture – that is objective. The pain can be exactly the same and be totally disabling in both cases but an insurance company may tell you that you don’t qualify where the evidence is subjective.It is important to know that very few policies exclude claims on this basis. You should request a copy of the policy to determine what exclusions apply to your plan. If you require help interpreting the policy, do not hesitate to contact us.
- In order to qualify, your disability must be “formally” diagnosed
Again, this would not be a requirement of most policies. There are many cases where doctors are confused as to the nature of the illness, disease or injury. In some cases doctors cannot make a definitive diagnosis. That does not mean you are not disabled and entitled to benefits.
- Your employee handbook contains all the information you need to make a claim
No it does not! The handbook may tell you what you are entitled to and how to apply but it does not contain the terms of the contract that the insurance company interprets to accept and deny your claim. You must get a copy of the contract to know what your full rights are and what the full obligations are of the insurance company. If it is a group policy through employment, the insurance company will rarely provide you with a copy of the contract. You must request a copy from your employer. The contracts are legal documents and are sometimes hard to understand – don’t hesitate to call one of our disability claim lawyers to help you interpret its language.
- If you can do any type of job then you are no longer eligible for benefits under “any occupation”
That may well be what your insurance company says but that is not the law. If you are disabled from similar jobs with similar status and reward then the insurance company is likely obligated to continue to pay. An accountant cannot be denied benefits because he or she may be able to work as a cashier.
- If you disagree with the decision to deny your claim, you can appeal
While this is correct, bear in mind that it is the very insurance company that denied your claim that is reviewing your file on the appeal. Also, it is important that you understand that time limits regarding your ability to sue the insurance company for denial of benefits continue to run. If you miss your time to sue, you may be forever barred from getting your benefits. It is essential that you seek legal advice the moment your claim is denied in the first instance.