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What NOT to Tell Your Individual or Group Long-Term Disability Insurance Adjustor

CA Disability Lawyers

You establish an income backup plan when you buy individual long-term disability insurance or receive group disability coverage at work. If you become disabled, you anticipate that your insurer will timely pay your claim. Unfortunately, it’s never that simple. You must provide timely notice of your claim and produce comprehensive proof of your disability. You must also be careful each time you interact with the insurance adjuster or anyone else involved in handling your claim. When you say the wrong thing, sometimes insurance companies deny your claim.

Insurance Companies Never Stop Investigating You

The long-term disability claim process is often disruptive and invasive. It’s challenging when you’re in pain or dealing with physical and mental challenges. You become the subject of medical and personal scrutiny. Insurance companies keep monitoring you even after they approve your claim.

Throughout the life of your disability claim, you must timely respond to multiple inquiries on demand.

  • Insurance investigators ask the same questions, looking for different responses.
  • IME doctors ask about your disabilities, looking for inconsistencies in your medical records.
  • Sometimes, you simply make small-talk to pass the time.

As you communicate in ways that you deem harmless, accurate, and appropriate, the people who control your claim look for inconsistencies. Even when you know they’re monitoring everything you say and do, it’s easy to say the wrong thing.

What Is The Wrong Thing?

The wrong thing is anything that gives the impression that you’re not truly disabled. You must think carefully before speaking to the disability claims adjuster or anyone representing your insurance company. Consider obtaining the services of a long-term disability lawyer so you don’t have to talk to the claims adjuster at all. You should also avoid talking about your disability with your neighbors. When an investigator conducts an activities check, neighbors often tell everything they know. Here are a few topics to avoid.

Don’t Discuss Your Job Dissatisfaction

At some point, an insurance adjuster, investigator, or IME doctor will ask about your on-the-job experiences. They want to know if you can physically and mentally do your occupation, but they also listen to anything else you say. When you talk about your job, stick with disability-related responses.

Avoid topics that give the impression that you don’t like your job or need an easy way out with pay:

  • Disputes with your employer or coworkers
  • Lack of promotions or inadequate pay
  • Unfair treatment or on the job harassment
  • Poor working conditions
  • Hostile work environment

When you discuss workplace issues, you introduce an alternate explanation for why you can’t work or the argument you should just change companies. It encourages an insurer to take a closer look at your claim and possibly deny it.

Don’t Share Your Vacation Plans

When you’re sick or in pain, a vacation is probably a good idea. Disability claims adjusters often look at your vacation from a less straightforward point of view. They wonder how you could be disabled and travel in a plane or take a long road trip. They consider whether you will be sitting on the beach, swimming, or even walking. If so, could you do these things if you were truly disabled? They also consider whether you simply made a disability claim to finance your vacation.

Don’t Share Any Travel Plans, For That Matter

Even if you’re just visiting family in the next county, don’t discuss it with the insurance adjuster. Claim examiners consider everything you do and how it relates to your disability claim. While you’re making small talk about seeing your family, they’re often thinking about the logistics: If you can sit in a car or even travel on a bus for a few hours, you can sit, focus, and concentrate at your desk and do your occupation.

Don’t Talk About Sick Family Members

Talk about your disability as much as you want but never discuss a family member’s illness. You don’t want the disability claim examiner to assume you need time off work to care for someone else or that you are caring for anyone else including grandchildren. If you talk about your spouse’s or elderly mother’s ongoing treatment, a claim rep must consider whether your disability is a convenient way to play a role in their daily care. While this is indeed admirable, if an adjuster finds that you’re providing even minimal caregiving services, they use the information against you to deny or delay your monthly disability insurance benefits.

Ask About Your Entitlement To Other Benefits

When the insurance company approves your disability claim, ask about other available benefits like life insurance waiver of premium. If you qualify for additional payments, your inquiries may lead to additional company-sponsored benefits.

When you’re dealing with a long-term disability adjuster, you can find out about additional benefits through a Summary Plan Description. If you need to know about other benefits, review your SPD or contact an ERISA disability lawyer to analyze it for additional entitlements or questions.

Don’t Talk About How You’ve Suffered For A Long Time

If you’re like most working people, you do everything you can to avoid taking disability leave. Perhaps you take over-the-counter pain meds or you avoid physical activities. That’s admirable, but if you talk to the adjuster about your long-term suffering, you introduce the possibility that you have a pre-existing condition. Some disability insurers cover pre-existing injuries under certain circumstances. In many instances, they deny payment for longstanding pre-disability claims.

Provide Only Accurate Details About Your Day-to-Day Activities

Throughout your disability claim, you will have many conversations with the insurance claim rep. Approach these conversations cautiously. Even if it seems the adjuster is just calling to see how you’re doing, don’t treat it like a social call. They’re always searching for any piece of information that proves your claim isn’t valid or that an activity is inconsistent with your restrictions and limitations.

If the adjuster asks, “How are you doing,” never say, “I’m fine.” Talk about your reality: your pain, difficulty moving, inability to lift, your need to hire help for household chores. Answer their questions with facts, and don’t volunteer irrelevant information. Don’t discuss your family, your plans, or even your morning walk.

Talk To The Adjuster Only While You’re At Home

When you’re disabled, you should be able to go to the playground with your grandchildren or eat dinner out at a restaurant. Of course, adjusters often have a different disability behavior standard.

If they envision your involvement in normal activities, they often imagine that you should be working. To avoid a claim dispute, don’t talk to your adjuster in locations where background noises say you’re out doing something normal. Again, it will be most beneficial to you to let a long-term disability lawyer handle any conversations with the insurance company on your behalf.

Do You Need An Individual Or Group Long-Term Disability Attorney?

When you file a disability insurance claim, adjusters use anything you say or do to reduce or deny your benefits. Individual and ERISA group disability attorneys can intervene on your behalf. They control insurance company interactions and help you prepare for independent medical exams or functional capacity evaluations. Attorneys provide valuable legal services to help you present your disability claim and overcome insurance company challenges and disputes.

When you schedule a complimentary consultation, a disability claims attorney discusses your claim and analyzes your insurance coverage. They review your legal options and determine if how they can help you.

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.

Request a Free, Confidential Case Review.
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