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Common Deceptive Disability Insurance Company Claim Tactics

Disability Insurance Attorney

Do you ever wonder how insurance companies make money? After all, the average cost of a long-term individual disability policy is only about $500 per year. However, if you qualify for individual or group long-term disability benefits, you might receive about 60 percent of your monthly income during your long-term disability eligibility period. The average worker will take home about $2,000 a month in individual or group disability benefits.

The math just doesn’t add up, yet the insurance industry is one of the largest, wealthiest industries in the United States. Why? They’re often experts at deceiving their claimants and wrongfully delaying, denying, and terminating individual or group long-term disability benefits. The more your long-term individual or group disability insurer has to pay out, the more likely you’ll face a sudden wrongful termination of your disability benefits.

We all know insurers make money by managing risk. They insure large pools of workers hoping that only a few will make small benefit claims, and then they will make more money than they pay out. Individual or group long-term disability benefits, however, can last until normal retirement age, and in some individual disability policies, for life. This means that even one individual or group long-term disability claimant can offset your insurer’s risk analysis for a small pool of employees.

Don’t let your individual or group disability insurance company fool you into accepting a sub-par settlement or convince you that you’re not entitled to disability benefits. The outstanding long-term individual disability lawyers and nationally renowned group ERISA insurance attorneys at DarrasLaw have more then 100 years of combined experience fighting America’s disability insurance companies after wrongful delays, denials, and terminations. Frank N. Darras, the nation’s top disability attorney, and his firms have recovered nearly $1 billion in wrongfully denied, delayed, or terminated insurance benefits. To schedule your completely free disability policy analysis and free disability claim consultation, contact our office today at 800-898-7299 or write to us online.

Prolonging the Disability Investigation Process

One of your long-term individual or group disability insurance company’s favorite tactics is to delay the review of your benefit determination by continually requesting duplicative evidence—far beyond what you’re required to provide.

Your individual or group long-term disability insurance company may also constantly change your claim’s adjuster, resetting the review process. Insurance companies change adjustors to prevent familiarity and an adjustor taking a liking to you or your condition. You may call one day to find that Sam is on leave, her replacement is out sick, and her boss is always on another call.

Delay serves multiple purposes:

  • It extends the period during which your disability insurer doesn’t have to pay benefits.
  • It shortens your disability payment period, because your individual or group disability insurance company anticipates you are approaching the recovery process.
  • It discourages claimants from continuing to pursue their claims because they must constantly request, pay for, and submit multiple, updated medical records, chart notes, and earnings information while they struggle with their disabilities.

While you do have to provide clinical documentation from a licensed medical provider to support your disability benefit claim, you don’t need to give the insurance company everything it requests. For example, if your medical records state that your back injury resulted from a recent car accident, your disability insurer can’t delay your benefits pending receipt of irrelevant medical records from 20 years ago. It may ask for previous medical records and films if it has a justifiable reason to believe you are actually suffering from a pre-existing back injury, but it cannot delay processing your claim because it has asked for 30 years of unrelated optometry records it hasn’t received.

Sending You for “Independent” Medical Examinations

Your individual or group long-term disability insurer has a right to send you to a third-party physician to verify your disability claims and restrictions. While this practice was originally intended to prevent insurance fraud, it’s become the go-to termination tactic of your individual or group disability insurer.

During these examinations, an insurance-company paid doctor—who may lack the proper training, specialization, or knowledge about your occupation—will conduct a brief medical examination, review your medical records, and typically find some way to claim you’re not disabled. Whether it’s commenting on how easily you walked into the exam room or lifted yourself on and off the exam table, the doctor will likely conclude that your disability has resolved or surely improved.

Insurance company-paid doctors who support benefit claims often find they’re no longer scheduled to conduct insurance examinations.

In some cases, a patient suffers from such a severe disability that it’s difficult for even an IME doctor to claim the condition has resolved. In this case, you’ll see insurance company-paid doctors throw around the “pre-existing” exclusion. Instead of claiming you’re not disabled, the doctor will claim the disability resulted from a degenerative condition or a fall from the playground when you were five—and that your individual or group long-term disability insurance does not cover your injury or illness.

Don’t feel discouraged if you receive a report from an “independent” physician or insurance company medical reviewer who downplays your injuries and associated suffering. It’s commonplace in the industry, and these so-called IME doctors will not have the last word when you have an experienced long-term individual or award-winning New York Insurance Bad Faith Lawyer from DarrasLaw on your side.


Additional Deceptive Practices

While individual and group disability insurance companies will use delay and short shrift reviews of your claim and manipulated so-called independent medical reports in many cases, the list of additional deceptive practices continues:

  • Twisting your job description – Based on your injuries, your insurance company may misrepresent your daily tasks so you appear able to perform the important duties of your occupation or you can do some other occupation they say is the same as yours.
  • Video surveillance – Can’t type for eight hours a day due to carpal tunnel syndrome? Your individual or group long-term disability insurance company may claim otherwise, because one of its investigators shot a three-minute video of you holding an umbrella or your keys.
  • Minimal submission requirements – Don’t let your individual or group long-term disability insurance company fool you if it isn’t asking for much medical or financial information after you’re approved for benefits. If you don’t submit updated medical records, pharmacy documentation and physician’s statements supporting your continued claim for benefits, you may face a wrongful termination of benefits.
  • Exclusion admissions – What may seem like a pleasant conversation with your individual or group disability insurance company’s representative about your military service can turn into a wrongful denial or reduction of your benefits because your insurance company believes you should have applied for benefits through the VA.


Remember, insurance is a for-profit business. If your valid disability claim eats into your individual or group long-term disability insurer’s bottom line, it will often do whatever it can to wrongfully delay, deny, or terminate your benefits.

Know Your Legal Rights: Call America’s Top-Rated Individual and Award-Winning Group Long-Term Disability Attorneys Today

If you are hurt and you’re disabled and your individual or group long-term disability insurance company will not help, you need someone who will fight for you. While you purchase insurance to relieve your financial burdens during a difficult period, your individual or group long-term disability company often adds insult to your sickness or injury.

Don’t be intimidated by your long-term disability insurer, because the award-winning long-term individual and nationally recognized group ERISA disability lawyers from DarrasLaw are here to help. We know your insurance company’s tricks, and we can help you fight for your right to wrongfully delayed, denied, or terminated long-term disability benefits. To schedule your free disability claim consultation and free policy analysis, call us today at 800-898-7299or contact us online.

DarrasLaw is Americas' most honored and decorated disability litigation firm in the country. Mr. Darras has seen more, evaluated more, litigated more, and resolved more individual and group long term disability and long-term care cases than any other lawyer in the United States.

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