New Video: Top 10 Mistakes Policyholders Make in Disability Claims

Frank N. Darras, America’s top disability lawyer, sees 2500 new referrals each month from policyholders across the country, Darras is the go to expert on mistakes policyholders make when filing an individual or long-term disability claim. In a recent video, he highlights the top 10 mistakes claimants make and how to avoid them.

Here’s a sneak peek at the list:

1. Fraudulent Misstatement: Anything materially misrepresented on your individual disability application is grounds for denial. Be sure to read over the policy before signing anything as it is possible for your agent or broker to mishear, misunderstand or misrecord information on the initial application that can and will be used against you.

2. Pre-existing Condition: Carriers are looking for anything in the policyholder’s medical history and records that they treated, consulted, took medication for, during the policy’s pre-existing look back period.

3. Policy Language Confusion: Policyholders frequently don’t understand the features, advantages, and benefits of their policy. An agent can promise a great policy, and policyholders trust them. The trouble is, most people don’t walk through the policy or pay close attention to the fine print. It’s important to understand how to use your policy before making a claim.

4. Carriers Call at Odd Times: Claim Examiners ask important and frame claim-ending questions, if you are busy, reschedule the call. Keep the conversation brief and ask the caller to put questions in writing, so there are no misunderstandings.

5. Documents: Once the carrier starts asking for documentation, it’s a “never-enough” cycle. They will even try to ask for some that policyholders aren’t legally obligated to provide, such as tax documents. Be careful and only give what’s needed and required.

6. Field Visit: A field visit should send a policyholder a “red flag alert”. Carriers aren’t trying to “better understand” the claim. They want to talk about the policyholder’s neighborhood, lifestyle and the kind of car they drive in an effort to find something they can use to deny the claim.

7. Surveillance: Be aware that field visits are always accompanied by surveillance. Carriers are trying to document any activities that the policyholder claims are limited or restricted. When filing, don’t use the words “always” and “never”. If a policyholder says they can never drive and the carrier finds them driving, a denial letter is in the works.

8. Functional Capacity Evaluation: This is an evaluation done by physical therapist that translates a 2-hour evaluation into a 40-hour work week. Policyholders often push themselves to do their very best. This is the worst thing to do. Do what you can safely and be vocal about your pain on a scale of 1-10.

9. Doc to Doc: Carriers will ask for the policyholder’s doctor to speak to their on-site physician. This is a recipe for disaster and no policy requires this step. Ask instead for them to have the policyholder’s doctor get and answer the questions in writing.

10. Appeal or Not? : After a denial letter is sent, group policyholders generally have 180 days to appeal. This is one of the toughest decisions and can mean the difference between a “bad faith” claim or later being able to file a lawsuit against the carrier. Seek a top disability lawyer to help answer this question.

“My best advice is don’t give up. Insurance companies will try to beat you up, wear you down, and starve you out. They know that the sick, or severely injured people can’t fight long. Don’t let that be the case.  Ask for real help before you make a fatal disability claim mistake,” says Darras.