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Disability Claimant Myths

Not a day goes by in which I do have to dispel at least one commonly held myth that a client espouses based on what they heard, believe, conjecture, fantasize, or otherwise invent.

The following is a list of myths commonly held by disability benefit claimants. All of these myths live up the exact definition of the term as “a widely held yet false notion,” collectively stated as follows:

    • If you write the insurance company an appeal with a letter from your doctor, they will pay your claim
      -Nothing is further from the truth. The insurance company has its own doctor(s) who will say otherwise which, in most cases, is all that is required to support their claim denial
    • My diagnosis alone means I am disabled
      -So Wrong. Diagnosis does not equal disability. There are many people with the same condition who are performing work daily. This approach loses every time.
    • My receiving Social Security Disability benefits means that I should received long term disability benefits
      – Wrong Again. Each system of benefits uses its own definition of “disability.” An award of SSD benefits is neverĀ automatically determinative of entitlement to long term disability benefits.
    • Detailed comments on an application will compel the insurer to pay benefits
      -Just the opposite. The more you tell the insurer, especially about personal activities, the more evidence you are handing them for further investigation of your claim (i.e., undercover video surveillance) and material by which to deny your claim.
    • Sending long protest letters with threats to get an attorney will convince the insurer to pay benefits
      -Nope. The insurer will make sure to say that your ability to write such long letters is evidence supportive of the contention that you are able to work. And, as for you lawyer threat??? Laughable. If you were inclined to get an attorney, you would have done so already. They are relying on you to be too cheap to pay for counsel and save the motherload of money by ultimately not paying benefits once you have exhausted your administrative appeals.
    • If I can’t do my job, I will get disability benefits
      -No Way. The language in most disability policies will stated that your “own occupation” is defined as now your job is performed generally in the national economy and not how your particular job was performed. This standard becomes even more harsh when the policy changes definition from “own occupation” to “any occupation” in which many other jobs can be offered for you to perform as long as they pay a certain salary amount. The insurer never has to prove it can get you another job in this process.
    • I can always get a lawyer later to win my case later
      -This is not realistic. Group plans are governed under ERISA which has a specific administrative review structure. If you do not produce the necessary evidence in the underlying appeal, you will not be allowed to introduce new evidence after a lawsuit is filed. Further, there are no jury trials in ERISA-based cases. You will not testify nor your doctors. The court proceedings are based only on the administrative record. Therefore, if you “played lawyer” on your administrative appeal, you may have sealed your fate as the necessary evidence cannot be introduced and you lost your benefits.
    • Representations by the insurance company representative that “they are here to help you” and “you do not need a lawyer yet”
      -Total Lies. The company is playing you for a sucker. If you do not put in the necessary information in the administrative appeal, then you will lose your case forever. To make sure this happens, it is important for the insurer to convince you not to seek legal assistance.
    • Lots of lawyers handle disability appeals
      -Believe this and you will be victimized twice. There are very few attorneys who handle these claims on a routine basis. Without the necessary experience and the ability to pursue cases in court which are wrongfully denied, a lawyer who says that he/she “will see what can be done” is only trying to make a fee out of you and will not lend any assistance in your case. The insurance companies know who the successful lawyers in the venue are and who will take them to task. Make sure to ask any prospective lawyer about their experience with the particular insurer, number of claims they have successfully appealed, and their court record.
    • My employer bought the disability policy to help me
      -Are You Kidding? Your employer bought the policy as a marketing tool to gain your services. As other companies offer disability insurance, it is incumbent upon them to offer similar coverage in order to secure your services. Many companies buy the lowest price coverage available from insurance companies with a poor history for paying claims. This way, they can say they provide coverage, but are really paying very little for what is an illusory product.
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