5 – Your claim is going to cost the insurance company money. Do the math. Multiply the amount of money you thought you were going to receive monthly by 12 months, then by the number of people filing a claim. Add to that equation the number of years you and all your fellow-claimants expect to be paid. The cost to the insurance company to pay each and every claim is a losing proposition for the insurance company. They have loss ratios – built in projections – to meet – irrespective of the claim merits. Jobs depend upon it. Their jobs.
4 – The insurance company didn’t count on so many people filing claims when you bought your long-term disability insurance policy. The “golden age” of long-term disability insurance policy sales took place when the companies targeted individuals known for high income and extended careers. Doctors didn’t stop working at any set age, dentists kept practicing until they sold their practices.
Despite the deep bench of math majors in the Risk Department, the actuaries didn’t count on social changes that led many high income professionals to stop working and file a claim. The policies were very generous – – and now, they’re too costly for the insurance company.
If your disability insurance claim has been denied, or if you are contemplating filing a claim, we invite you to call our office and discuss your situation. The call is free – 877-583-2524 – there’s no obligation.
3 – Your medical records don’t support your claim. Medical records and support from your treating doctor are the cornerstone of a long-term disability claim. A note from the doctor stating you are disabled is not enough. We dedicate a lot of time making sure medical records support the issues, and can withstand a challenge from scrutiny. We also work with treating physicians to ensure medical records document not just that you are disabled, but how your disability impacts your ability to perform the material and substantive duties of your occupation.
Your compliance with the recommendations from your treating physician is another critical part of the success or failure of a disability claim. If the doctor advised you to return on a quarterly basis for an evaluation and you fail to do so, the insurance company will target this as proof you’re not really disabled. If your disability is “self-diagnosed,” that is, you realized you could not work and simply stopped, the insurance company will say you have no claim. The issue of “appropriate care and treatment” is a trending defense raised by insurers.
2 – There’s little risk or penalty to the insurance company to deny your claim. We use a logo of an unbalanced seesaw to demonstrate what we think the main problem claimants face. Long-term disability insurance companies have all the advantages. If your claim is denied, the money you expected to receive to pay bills, maintain a lifestyle and protect your family is gone. The results are bad. For the disability insurance company, denying your claim is a no-cost risk.
You cannot sue the insurance company for damages for willfully denying a legitimate claim. It’s not part of the contract. There’s no penalty to the insurance company for making your life miserable and adding to the burden presented by a disability. Few states permit bad faith claims, and ERISA claims do not allow for bad faith. Millions of dollars and thousands of employees and subcontractors are already in place to deny your claim, make you go through unwanted medical exams, cherry pick medical records and lose documents. It costs the insurance company nothing, but your financial losses could be devastating.
1 – The more claims denied, the better the profits for the insurance company. When the interest rate environment was very low, insurance companies tightened the reins to maintain their profits. When COVID struck and the number of claims for life insurance and disability insurance benefits skyrocketed, the insurance companies pushed back. With the volatile markets of the last few weeks, the move to protect profits will drive even more claim denials.
CEOs must deliver results. Your claim may be part of that “result.”
If your disability insurance claim has been denied, or if you are contemplating filing a claim, we invite you to call our office and discuss your situation. The call is free – 877-583-2524 – there’s no obligation. At the very least, you’ll likely learn something. It’s well worth your time.