MISTAKES

10TO AVOID ININDIVIDUALDISABILITYINSURANCECLAIMS01

AVOID THE "FRAUDULENTMISSTATEMENT" PROVISION.

Information can be misheard, misunderstood orinaccurately recorded when relayed to theinsurance company. Before you file, closely reviewthe medical, occupation and financial informationto flush out anything that was inaccurate ormisleading.1

If the insurance tries to rescind your policy, DO NOT cash therecission check!

CONFUSION ABOUT POLICYLANGUAGE.

Most policyholders don't pay close enoughattention to the fine print, so be careful.Carriers love to argue that you really have adual occupation at the onset of the claim andtherefore never qualify for total disability.2

FAILURE TO PROVIDEOCCUPATIONAL DEMANDS.

Arm your treating doctors with all theinformation they need to answer theinsurance carrier's questions about thephysical and mental demands of your work.3

POSTING ON SOCIAL MEDIA.

4 Facebook, Twitter, LinkedIn and Instagramupdates document happy events in ourlives, but rarely reflect the realities of adisability. Know that your carrier is watchingyour Internet activity and that posts aboutyour activities will jeopardize your claim.

UNDERSTATING YOURACTIVITIES ON CLAIM FORMS.

5What you say on your claim forms will beused against you. If you say you can neverlift more than five pounds or you’re neverable to sit for long, plan on your carriersending out the “paparazzi” to videotapeyour daily activities. When filling out yourforms, don’t use the words “always” or“never.” Be as accurate as possible.

PROVIDING MOREDOCUMENTS THAN REQUIRED.

6Often, carriers will try to ask fordocumentation that policyholders aren’tlegally obligated to provide, such as taxdocuments. Only give what’s needed andseek out an experienced disability attorneyif you’re uncertain about what’s required.

EXACERBATING YOURCONDITION DURING A FUNCTIONALCAPACITY EVALUATION.Many policyholders push themselves to do theirbest during a functional capacity evaluation(FCE), but you should only perform what can bedone safely. You should also be vocal about yourpain on a scale of 1-10 as the exam progresses.7

ALLOWING YOUR PHYSICIANTO SPEAK TO THE CARRIER'SON-SITE PHYSICIAN.8This is a recipe for disaster and no policyrequires this step. Instead. ask for theon-site physician to send your doctor thequestions in writing, so that after carefulreflection, no mistakes are made.

FAILURE TO DISCLOSEPRE-EXISTING CONDITIONS.9If your carrier can't take away your policy forfraud, and your disability began within twoyears after purchase, the next best carrierdefense is arguing that anything you failedto disclose is a pre-existing condition.

If that strategy fails, the carrier will look for care or treatmentduring the pre-existing period to deny benefits.

DECIDING TO APPEALWITHOUT PROPER COUNSEL.

01After a denial letter is sent, policyholdersgenerally have a right to appeal. This is adifficult decision and can mean thedifference between bringing a bad faithclaim and giving the carrier theopportunity to fix the unreasonable claimhandling.

Seek an experienced, top-rated disability lawyer to help answerthis important question.

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