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When you have been in this business as long as someone like me, you would think you have seen it all. Then, the insurers will amaze you at what new machinations they will attempt to screw over their insureds. The following is only a partial list of the more offensive tactics employed in the past few years which have raised my ire.

  1. Claim Denial Shortly Before Payment End DateI have seen instances when the insurer will purposefully deny a claim with only a few months of payments remaining before the claim reaches a final payment due to “aging out” as a claimant reaches an end date or age resulting in automatic termination of their benefit payments. In many cases, the insured has been receiving payment for some years prior to suffering this final dagger to the heart. What is particularly disturbing is the way the insurers take advantage of the situation as the insured cannot afford to pay an attorney to fight to restore benefits and there are only limited benefits available such that a contingency fee does not come close to covering a fair attorney fee.
  2. Lousy Settlement Offer/Claim Denial Combination Platter.Sometimes, claimants will receive an unsolicited offer of settlement of their claim from a disability insurer. In some cases, this is not so much of an offer, but a threat of claim termination should the insurer not accept the paltry sum being offered to settle their claim. (In the vein of my favorite movie, “The Godfather,” the insurers are “making you an offer you no can’t refuse.”) This carrot and stick approach never leaves a good taste in an insured’s mouth as, more often than not, they will have to appeal a subsequent claim denial when the insurer’s cost saving settlement offer is not accepted.
  3. Mischaracterizing Medical Evidence So As To Limit Recovery for Mental IllnessMany claimants do not read their entire disability plan. Most plans have a mental illness limitation exclusion which will limit recovery of disability benefits to 24 months if the disability is the result of a mental illness. It should not come as any surprise that most people suffering from a disabled also become downcast and/or anxious. It is very common for such persons to eventually receive a diagnosed of anxiety or depression. Rather than treating this new diagnosis as a product of the disability, some insurers will treat it as the primary cause of disability so as to limit the payment of benefits. This is a nice insult to injury for claimants.
  4. Claim Denial Based on Improvement In Condition Despite No Supporting EvidenceEven when the claimant produces routine, consistent evidence that their condition has not improved in any way, insurers will still find ways to deny claims. This is done in several ways. The most corrupt is the use of the word “stable” which means “unchanging” in medical reports from treating physicians. This descriptor will be twisted by the insurer to mean that “all is well” and the go on to state that a claimant has improved. Then, the claim is denied on this basis. Another ridiculous tactic is the generalization that “as no objective evidence of disability has been set forth, then it is obvious that the claimant’s condition has improved.” By this reasoning, a claimant will now be placed in a position to disprove a negative. Further, nearly no policies require proof in the form of “objective evidence” which the insurer has improperly added to the definition of “disability” to suit its own nefarious end to deny the claim. Of course, the insurer always has a reviewing physician ready to sign a report to support these conclusions without ever examining the Claimant.
  5. Transporting Claimants Long Distances For EvaluationsThe insurers only have a limited supply of physicians and other examiners who are willing to “whore” their credentials for the purpose of denying disability claims. Therefore, insurers are more than willing to insist that claimants travel long distances (in many cases, several hours of driving) to attend “independent” evaluations. In cases where claimants are not capable of driving, the insurers will offer transportation services for this purpose. In the end, it is always the same conclusion where the claimant is taken to a slaughterhouse for disposal.
Posted in General Disability Issues | Tagged , , |


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