- If you follow the rules when filing your claim and explain your situation the insurance company will approve your claim.
- If you fill out the form the insurance company sends, you will get your benefits.
- If you have been awarded Social Security disability benefits you will have no problem getting your claim approved.
- The “activity log” the insurance company sends you is to help them understand your disability and approve your benefits.
- Writing a long letter detailing your case and the ways that your medical condition disables you will help to get your claim approved.
- If your doctor writes to your insurance company stating that you are disabled you will be granted benefits.
- If your employer tells the insurance company that you are too disabled to work for them you will be granted benefits.
- Insurance companies are businesses. The more money they make for their shareholders, the better. They will do whatever they can to deny your claim.
- Insurance companies send forms to help them deny claims. By asking questions that are irrelevant to your disability they can claim “you’re not disabled! Your legs work perfectly!” when you submitted a fatigue claim.
- Insurance companies have argued that they do not need to follow a Social Security determination—even though SS has the strictest standards—and courts have affirmed this!
- The activity log is often compared to videotaped surveillance to find a “gotcha!” moment to use as the basis for denying your claim.
- The insurance company will look at your long, well-written letter and say, “Look! You CAN work!” and deny your benefits.
- The insurance company is not required to follow your doctor’s recommendation. In fact, they will likely hire an “independent” medical examiner to look over your records, declare “He can work,” and give an M.D. “seal” on the insurance company’s denial.
- Once again, the insurance company is not required to follow your employer’s recommendation. Insurance companies will, by and large, discard letters from the people who know you best and can appropriately testify about your disability.
What You Can Do:
- Dot all of your “i”s and cross all your “t”s. Get everything in order before you leave work and before you submit a claim.
- Never lie on your claims—it will absolutely come out in the end—but be sure you send all of your documentation. Just filling out their forms will get you nowhere.
- Do not use the insurance company’s lawyer to pursue your Social Security benefits. The insurance company may offer a lawyer for free but this is a trick to make you dependent on them.
- Again, never lie on your claims—it will come out. Also, always follow the limitations your doctors set for you; you never know when you are being filmed.
- While you should be sure your claim is clear about what your disability is, let the letters from your doctors and other medical evidence do most of the talking. If your claim has been denied, hire a lawyer to do the talking! Our next book, Don’t Try This At Home, explains why it is so critical to have an ERISA-experienced lawyer work on your appeal.
- Your doctor is well trained to care for you. But he/she probably is not trained on how to fill out your insurance company’s very intentionally tricky forms. The most important fix is making sure your doctor uses the POLICY definition of disability. The definition in your policy is often easier to meet than the definition your physician is used to using.
- Collect and send in these letter anyway! It makes it easier in court to show that the insurance company made an unreasonable decision (“arbitrary and capricious”) if you can point to all the letters they wrongfully ignored.