Long term disability insurance companies (like UNUM, Prudential, Fortis, Reliance Standard, The Hartford, CIGNA, MassMutual, ING, SunLife Financial, Liberty Life, GE Financial, High Mark, MONY, Aetna, New York Life, MetLife, Paul Revere. Northwestern Mutual or any of the other disability insurers) make money by acquiring premiums, investing the premiums, and paying as few claims as possible, with the idea of making more money from the investments in the interim period.
Here is the catch – their premiums alone guarantee a profit. But they want more, so, they deny worthy claims and force you to appeal but not everyone has the capacity or ability to fight. While this is unfair and blatantly wrong, it is far more unsavory than that.
The long-term disability insurers know how to pick their victims – disabled individuals (like you) who are living on limited funds, focused on improving your health and family, and not really paying attention to the insurer’s activities. These companies know that kicking you when you are down is the best time because it makes it harder to fight back.
A termination or denial overwhelms you and places economic and time pressures on you. The long-term disability insurer is counting on you to simply give up (as many others do) or that you will be unable to locate a competent long-term disability attorney to help.
Now, the insurer will not directly approach you and tell you they are conducting an investigation. Sometimes (though not always), they may send you a letter saying they are conducting a review of some sort as part of their “ongoing investigation” of your claim. As part of this routine inquiry, the insurer may be undertaking any of the following unsavory activities:
1. Direct Provider Contact. This is comprised of having an internal nurse or physician contact your treatment provider(s) in order to acquire statements which can (and will) be utilized to deny your claim. This may include the infamous “what we discussed” letter which concludes with a statement that if your provider does not respond then the statements will be deemed truthful. Importantly, the insurer knows the doctor will likely never see the letter; and not surprisingly, often what is written directly conflicts with the actual medical records. To the extent you are able, you should only give the insurer information in writing from your doctor and only authorize your provider to provide information in writing on your claim to the insurer.
2. Background Information Check. The insurer will research your assets like your vehicles, real estate, bank accounts, and credit information. The insurers want this information to find out if you have sufficient resources to “sustain litigation” if they decide to deny your claim.
3. Active Surveillance/IME. The insurer will hire an investigator to stake out your house for a few days to check on your activities. They may also have their minions perform a more invasive surveillance – a medical examination. Their investigator may follow you to and from the exam; and even wait in the waiting room with you. Surveillance is very suspect and paints a half-finished picture. While the investigator may catch you walking from your car to a restaurant one day, what they don’t catch is how long you have to sit there in the restaurant before moving to your seat and the difficulty you have doing so. It doesn’t matter. They will have what they want and use it against you. You should always be vigilant.
4. Home Interview. Always decline this request. The insurer and their investigator will pretend niceness, but they are constantly looking for anything to help deny your claim – things such as general cleanliness, pictures of you doing things, how quick you move to the phone, and your ability to make yourself comfortable. Whatever they can hold against you in their report, they will. Best option is to conduct all interviews in writing and with the help of an experienced long-term disability attorney.
If any of these four things pop up during your claim, chances are the long-term disability insurer is looking for a way to stop paying you so that their pockets get fatter. It is an ugly and sad truth. Please prepare yourself, stay vigilant and obtain help if you need it.