The following is a top ten list of things you just do not do when it comes to disability administrators or insurers:
#1 DO NOT APPEAL YOUR CLAIM WITHOUT EXPERIENCED REPRESENTATION
To appeal your own claim is to become your own attorney...and you will not be able to sue yourself for malpractice. The majority of disability plans only allow a single appeal as required under ERISA (Employee Retirement Income Security Act of 1974). After that, the claim file closes and you will not be able to submit new evidence. Further, there are no jury trials in most circumstances. So, you will not be able to question the insurer, produce witnesses, or have a jury of your peers make the judgement. The final decision is made by a judge based on the claim file alone. Therefore, your one appeal can (and usually will) decide whether the whole case can be won in subsequent litigation.
The importance of developing the claim file is of such importance that this firm no longer accepts cases which it has not participated in the appeal process.
#2 DO NOT ALLOW THE INSURER TO HAVE ACCESS TO YOUR BANK ACCOUNT
The insurer will lie to you and tell you that they can only pay you via direct deposit. This is not true. They write checks every day to claimants just like you. The real reason the insurer insists on this protocol is to gain access to your bank account. The access granted to the insurer does not just work for deposits, but also withdrawals. For any reason should you be overpaid by the insurer, it has access to take money out of your account without giving any advance notice. In the end, it is much safer to receive a check a couple days later than have your money subject to removal at the insurer's whim.
#3 DO NOT ALLOW THE INSURER INTO YOUR HOME
Many insurers will require an interview with you which they will travel to your home. Many of the investigators will take great license with an invitation into your home. They will comment on various items around the house, hoping to prompt you into conversation by which to elicit statements which will be mischaracterized and utilized as "discrepancies" by which to springboard from and deny your case. The investigators will comment on the cleanliness of your home, whether you use any assistive equipment, how well you move about the premises, etc. Therefore, never let these persons into your home. Should they need to meet with you, just choose a local restaurant, library, coffee house, etc. I have them come to my office and make them uncomfortable while my clients have their say rather than being subjected to prolonged interrogation.
#4 DO NOT ALLOW THE INSURER TO INTERVIEW YOU FOR HOURS
The investigators sent to interview will take their sweet time. Some insurers will take up to three hours or more if you let them. There is no requirement that you have to be interviewed in a prolonged fashion. The insurers will use the fact that you were able to interview for a prolonged time as evidence of your ability to work throughout the entirety of a workday. The same goes for interviews on the phone. Keep to the facts and do not offer additional information If they cannot get the information in that time........well that's just too bad for them. The insurer's love to ask when your next doctor appointment is so as to get the surveillance folks out there. They will also love to discuss your hobbies or interests so as to try to get information revealing activity that they will term "work activity: by which to deny your claim . Don't fall for this.
When insurers come to my office they are told that they have exactly one hour for the interview unless they plan to pay for my next hour. I have never had an interview go longer than the one hour.
#5 DO NOT RETAIN JUST ANY ATTORNEY
Make sure that an attorney you hire has extensive experience in handling not just disability cases, but also cases from the particular insurer in question. There are many attorneys who will be happy "to see what they can do." A comment like this should give you instant pause as it reflects nothing but inexperience in this subject matter. Asking questions about the attorneys record concerning your type of disability and general litigation record are excellent points of discussion which will allow you to probe the competence level of a practitioner.
If you present your case to this firm, we will discuss how we proceed and the general expectations given the particular insurer. We will also tell you about inside information on the insurer we have obtained over the years. Try asking any other attorney is they have such information. Few will be able to match our insurer "bad conduct" database.