The disability insurers play for keeps. In most cases, they serve in the conflicted position as both insurer and payor of claims. Therefore, you literally have the fox guarding the hen house. Since insurers loathe paying claims (which represent no more than a reduction in their corporate assets), you must expect that the insurers will “game” the system by using all the dirty tricks they can. Here are a smattering of these nefarious insurer moves:
1. Sandbagging - The insurer will gather new evidence, including newly recruited medical and vocational reviews (sometimes multiple) on which they will base a final denial. Afterwards, the insurer will not consider any information offered in rebuttal of these newly obtained opinions.
2. Late Examination Requests - Late into the appeal period, the insurer will demand an “independent” (read, “defense”) examination of the claimant in order to create a better denial of the claim and delay the entire appeal process.
3. Backdating Documents - I have seen several occasions in which the insurer will deliberately backdate documents in order to meet ERISA-based deadlines. Unfortunately, the insurer will not change the date stamp on the mailing envelope. Therefore, it is very important to keep the mailing envelopes in any case where a deadline may have been missed by the insurer.
4. Pretending Not to Receive Documents - Several weeks into an appeal, an insurer will claim that you have not provided documents mentioned in your appeal. The insurer will then demand an extension of time due to this false claim.
5. Delaying Production of Documents - Even if you request the claim file, you will commonly find references to video surveillance reporting, but no actual video footage included. Why? This is obvious. The insurer does not want you to see what the actual footage shows as opposed to the exaggerated claims made in its reporting.
6. Denying Claims at a Future Date - This is an extremely nasty tactic. My favorite example of this tactic is a benefits denial which terminated my client’s disability claim four months from the date the denial letter was sent (???). Since you have only 180 days to appeal the decision, this maneuver only left 60 days when the client was found to be “not disabled” by which to acquire documentation to prove continuing disability. This led to a very bad confrontation from the outset over the exact date for which the appeal would be due. I was eventually successful in making the insurer look bad, ceding my point, and extending the date when the appeal would be due.
7. Repetitively Phone Interviewing the Claimant - What you tell the insurer on the phone may not be what is being recorded in the claim notes. Typically, the insurer will take liberties with a claimant’s statements in order to minimize their complaints and reflect greater than stated activities in an effort to undermine a claimant’s credibility.
8. Extensive Investigative Efforts - The insurer will undertake extensive investigation of claimants via several background databases in addition to checking social media activities in search of anything which resembles work or recreational activity which can be characterized as not supporting disability.
9. Not Contacting Treating Physicians - On many occasions, the insurer will employ a medical reviewer who will make no effort to contact your treating physician to verify the substance of the opinion rendered. Even when the reviewer does contact the physician, the reviewer will either (1) leave a single message during busy, daytime working hours or (2) send a letter stating the reviewer’s opinion with a short deadline to confirm concurrence with its opinions.
10. Demanding Personal Interviews - Many insurers will demand personal interviews with claimants in their homes. The purpose of these interviews is to keep them going for as long as possible so to observe the claimant remaining responsive for a long period of time. While at it, the investigator will make observations about the condition of your home and ask many questions designed to elicit statements about any hobby/craft/household activities which can be characterized as indicating an ability to work.
This firm shields its clients from the prying eyes of the insurers while doing its best to keep them honest by holding them to deadlines and preventing/circumventing the type of behavior we have described in this article.