Question 1

Can My Insurance Company Force Me To Have Surgery?

Accepted Answer

Your insurance company says you need surgery. Can they make you have surgery? No, but they can enforce a provision that says you need to be under the most appropriate care for the condition causing disability. So if surgery is an option, we look at the risk factors. Is it more than 50%, that the risks outweigh the benefits? Then you can argue, no. It’s too risky.

What if, when you had your wisdom teeth out, you had a terrible reaction to anesthesia? You were pregnant, you had an epidural, you had a terrible reaction to it. You had a minor surgery and the healing process was really, really difficult. Those are risks. The risks outweigh the benefits, the insurance company can’t make any good argument about needing surgery.

Question 2

Can the Insurance Company Investigate My Past And Interview People About My Credibility?

Accepted Answer

We often hear about ex-boyfriends, ex-business partners, ex-wives, ex-girlfriends. Why would a carrier want to interview all those exes? Because when you file your claim for disability, the insurance company wants to put you at the top of the ugly tree.

They’re going to talk to everybody who’s got something to talk about in terms of veracity, or your credibility, or you didn’t tell the truth, or you cheated on her or you’re cheated your partner out of this or that.

So if you got prior lawsuits, if you got prior partners, ex-wives, ex-girlfriends, be prepared. The carrier will investigate and try and prove that you’re untrustworthy, you’re un-credible, you don’t tell the truth, and therefore they can discount all your complaints of pain and limitation.

Question 3

Can the Insurance Company Run Surveillance on Me?

Accepted Answer

It depends. Insurance companies are entitled to evaluate what you said on your claim forms with how you appear in public. So once you leave your house if you are in a public setting, you’re driving, your shopping, you’re at the movies, you’re at dinner, you said you can’t sit, you can’t bend, you can’t stoop, you can’t push, you can’t pull, do you think they might want to see you at Walmart or Costco bending over to get some detergent.

Question 4

How can my Social Media Activity Affect my Long Term Disability Claim?

Accepted Answer

Social media and your activity can devastate your long term disability claim. If you’ve been disabled for over two years, why does your LinkedIn profile show you as an Executive Vice President of your last company? Why does Facebook show you at a concert or at a wedding, or with dance pictures? Pinterest activities, all the social media problems, Twitter– I don’t go out during the day, but boy oh boy, there’s those tweets of you at some place during a time that you said you were going to be home.

Social media doesn’t show the sadness. It doesn’t impart your depression it doesn’t tell the story about not being able to bend or lift or stoop, or push or pull. Facebook, just because you’re private, doesn’t mean the insurance company isn’t friending your friend to be able to get in to take a look at your pictures.

Pictures are worth a thousand words. And in your long term disability case, a bad picture equals denial.

Question 5

What If The Insurance Company Wants To Speak With Your Doctor?

Accepted Answer

One of the most subtle tricks insurance companies use is to try and get your doctor on the phone during the middle of a busy day. Oh sure, she’s just going to drop everything and remember your file after seeing 40 patients in her office earlier that day. You can avoid that. Make sure the insurance company sends your doctor a list of questions in writing. Or they plan a time when your doctor’s got your file, you’ve provided the job description, you’ve also alerted your doctor about your restrictions and limitations.

Don’t forget the cognitive side effects from the medication. You can’t focus, hard to concentrate, can’t stay on task, and the sleep disruption. It’s hard to get to sleep, stay asleep, and wake up refreshed from sleep. Your doctor can do a good job when he speaks with the insurance company doctor if you’ve been a good patient in terms of laying out your problems

Question 6

My Insurance Company Wants Me To Apply For Social Security Disability Benefits. Am I Required to Apply?

Accepted Answer

We often hear insurance companies requesting that you apply for Social Security disability benefits. Always check your certificate or your policy for the offsets, the other income provisions. Your insurance company can offset, dollar for dollar, for the money that you received or that you’re eligible to receive from Social Security disability.

It helps if you apply and you’re found disabled, because if you’re in the own occupation period, where you’re protected because you can’t do your occupation, and Social Security finds that you’re disabled from any occupation, they must give that finding significant weight.

If, on the other hand, you don’t have a very good treatment record, you haven’t been able to afford medications or to see the doctor because you lost your coverage, probably not the time to apply for Social Security disability. One of those tricky areas that you probably should get some help before you do anything.

Question 7

Should I Submit to a Field Visit?

Accepted Answer

Your insurance company calls and says they want to do a field visit to better understand your claim at a local level. Or the carrier calls and says, we really want a two day functional capacity evaluation where we can see how much you bend, lift, stoop, push, pull, carry. Or gee whiz, Frank. They want to get me independently medically examined. And I’m not sure the doctor they’ve selected is so darn independent.

Question 8

Should I Turn Over Documents to the Insurance Company?

Accepted Answer

Oftentimes, we hear the insurance company is interested in more documentation. They may want to look at your state and federal tax returns. You’ve got privileges that you can assert to avoid having to turn over a state tax return. Federal tax return, a little different. I suggest you contact a lawyer before you turn over any state or federal tax returns.

Mental nervous claims, interesting issue about whether the insurance company can get your psychotherapist’s records, get your psychometric testing, or get your psychiatrist’s notes. Again, very important: Before you sign an open authorization, that you get some help from a lawyer familiar with this space.

Last, occupational information– how far back should we let an insurance company go to look at our employment history? Again, it’s important to get helpful advice from a lawyer familiar with the space, so you’re not giving too much, and you’re not failing to cooperate.

Question 9

Is the Insurance Company Entitled to my State and Federal Tax Returns?

Accepted Answer

Broad authorizations and the requests for tax returns, state and federal, can the carrier command you to respond? Yes, and yes. Unfortunately, the carrier has language in most of their policies that allows them to ask for state and federal tax returns because they want to see how much money you were earning at the onset of the claim.

They also want to see whether you were engaged in a couple of occupations. Let’s say you were a doctor, but your wife had a business. And you were the vice president of that corporation in addition to your hands-on duty as a doctor. The carrier wants the tax returns to be able to see what you’re engaged in and how much money you’re making.

Secondly, the carrier drafts an authorization broadly so they can go get your medical records. They can get financial information. And when you line out, you cross out, and you interlineate on that authorization, the carrier is going to argue you failed to cooperate.

Frequently Asked Questions

Can My Insurance Company Do That?

Technical Terms in Plain English

Nuts & Bolts of Filing for Disability

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