Here’s the hard truth: long term disability insurance companies have entire teams of analysts and actuaries who calculate the dollar value of every single kind of LTD claim there is. They know what the cost will be if a 54 year old male has an orthopedic injury, say a ruptured disc, how long he will be unable to perform the material duties of his occupation, and what the overall cost of the claim will be over the life of the claim.
This is the nature of the disability insurance business, and why it’s such a great business to be in. But if you are a claimant, the numbers may not add up for you.
The overall goal of the long term disability insurance company is, frankly, to minimize its exposure. That means thinking proactively about getting a claimant back to work, or denying, delaying or terminating their benefits. It’s purely a numbers decision for the disability insurance company.
For “mental/nervous” disability claims, most LTD policies limit coverage for a two-year time period. This makes life very difficult for claimants whose disability does not recognize the same time frame as the insurance company. In these situations, even if someone remains disabled after two years, if their disability is due to a mental health problem, their benefits terminate. One particularly nasty technique we have seen occurs when an adjuster tries to change a claimant’s medical status from a physical illness or injury to a mental/nervous claim. This is a strategic move to try to limit the amount of time that benefits can be paid, and thus, save the disability insurance company a substantial amount of money.
A steady emphasis on medical examinations, Functional Capacity Examinations (FCEs) and providing medical reports on a regular basis serves two purposes. The adjuster or the third party company that reviews medical records can see if the claimant is making any progress. But it is also a constant search for information that may lead to a denial or termination of claim. Insurance companies suspect that people prefer to be disabled and receive benefits, rather than getting better and putting their lives back to normal.
For all of the years that we have practiced in the disability insurance law area, we know all too well how our clients wish they could simply wake up and be well, go to work and resume their old lives. Facing the constant scrutiny of an insurance company or its hired guns, concerns about surprise investigative visits or surveillance, worrying that any day will bring a letter announcing the termination of benefits, on top of the illness or injury that led to the claim in the first place, is a debilitating emotional rollercoaster.
How long can you expect to receive long term disability insurance benefits? This is a complex calculation that involves the type of disability, your age and your income, among other things. If you are concerned that the disability insurance company is running the numbers on your claim and preparing to terminate your claim, call our office at 877-LTD-CLAIM (877-583-2524) to find out how we can help.