Wrongful Denial and Disability Fraud: Big Difference or Fine Line

Disability insurance companies are taking a closer look at claims filed in the New Year.

February 05, 2013

As disability insurance claims are on the rise and President Obama faces pressure to make budget cuts, the Social Security disability trust fund could fail to cover all benefits in early 2016. Disability insurance companies, facing similar budget concerns, are also taking a closer look at claims filed in the New Year.

"Anytime disability claims rise without explanation or budgets become tight, insurance companies and the Social Security Administration are going to take a closer look at claims being filed. In this case, both a rise in claims and a narrowing budget are concerns and companies are not ignoring that," says Frank N. Darras, America's top insurance lawyer.

The likely response to the rise in disability claims is more intense investigations by the insurance company to ensure that disability fraud is not being committed. It's important for those truly disabled to know how to file a claim correctly to avoid being accused of disability fraud.

"There are a lot of cases where disability fraud occurs. People lie and that is wrong. The worst part is those cases make insurance companies look at every claim with a discerning eye. If a claim is not filed correctly, it's possible that a person truly deserving of their disability insurance benefit could be wrongfully accused," says Darras.

Those seeking to file a claim should keep records of all doctor visits, pharmacy receipts, testing and medical paperwork. They should also share with their treating physician the job description and demands expected and why their restrictions and limitations medically prevent them from safely working. Deadlines should always be timely met, as turning in paperwork late is a common cause for claims denial.

"Make sure you are in regular communication with the claims examiner working on your case and maintain a good relationship with them. Listen carefully to their instructions and call if you have questions rather than making a mistake that could cost you your benefits," says Darras.

Even after following instructions, it's also possible that the insurance company wrongfully denies a policyholder's claim. This is an unfortunate situation and one that may become more common as claims rise and companies struggle to make ends meet.

"While the denial could be a mistake on the part of the individual filing the claim, wrongful denials do happen. At DarrasLaw, we deal with disability delays and denials on a daily basis and are constantly holding big insurance companies accountable to their policyholders. If you believe you are being delayed or wrongfully denied, make sure to contact a top disability lawyer right away," says Darras.