Here’s the good news: not always. The bad news, however, is that depending on the terms and provisions of your long term disability contract, in most cases you are required to provide the insurance company or third party company managing the claim with a lot more information than you ‘d probably like.
The details are in the policy, and this is where most people run into trouble. If you haven’t already read through your policy, you’ll want to take a look at the provisions concerning information that you are obligated to provide. The biggest problem you may face: these are complex documents and frankly, your understanding of what is legally required may be inaccurate or may conflict with the insurance company.
This is an example of the common problems that our disability law firm sees when claims are denied. Not complying with the specific requests that you are legally bound to produce can create problems that lead to denials, which lead to strict time deadlines. We do recommend that people who are not able to determine what they are required to provide contact our firm to discuss this issue.
If you are a business owner or medical professional with an Individually Owned Disability Policy, the insurance company is going to want to go through your finances in great detail. The reason is simple: if your monthly benefits are based on income, they are going to want to be certain that their payments accurately reflect your current income. They will also want to know your income from all businesses and any other sources of income. Do not be surprised if you receive a sweeping request for financial documents and tax returns for the past five years. Depending on the size of the claim and the amount of time the disability insurance company expects to pay your claim, they may ask for financial documents going back even further. Sometimes, the insurance company may even seek a financial audit of your practice.
For medical records, in most instances you will have to provide all information from all treating doctors. We believe that you are best served by contacting our law firm to discuss your situation with an experienced long term disability insurance attorney. There are medical records release forms that the insurance company may send you that may give the insurance company the right to access more medical records than are described in the terms of your policy. This is another point where claimants get into trouble. If you do not fill out the release form, does the insurance company have the right to automatically deny your claim? Or, if you do fill out the release form but it gives permission for the insurance company to access records that are different than what is described in your policy, do you have the right to refuse to provide the records? Can you somehow limit the “scope” of the authorization? We often counsel our clients concerning the scope of the authorization they provide to the disability insurance company.
Our experience, which includes many successful cases for both ERISA disability policies and privately owned policies, is that the records gathering process can become problematic in many different ways. A few things to keep in mind:
If you have questions about the types of records that the disability insurance company is entitled to receive, please call our office today at 877-LTD-CLAIM (877-583-2524).
Jason Newfield is a founding partner of the disability insurance law firm Frankel & Newfield. He has spent the majority of his legal career advocating for the rights of disabled workers. He has lectured other professionals, worked on a Federal Advisory committee, and published many articles in the field of disability insurance claims and litigation.
Secrets the Disability Insurance Companies Don't Want You to Know!