In last week's Disability Benefit Tip of the Week, we suggested that every time you talk to someone about your disability claim, you should keep notes about who you speak with, including their name, phone number and extension, the date, and the time, as well as what you discussed. Here are some additional tips for speaking with claims administrators.
It is important to remember that when dealing with adjusters that they are paid by the insurance company (or an ERISA plan's third party administrator). They have a vested interest in denying your claim. The insurance companies are running a business, and they only make money when they collect more money in premiums than they pay out in benefits. That means they are looking for reasons to deny your claim.
It is important to remember that when dealing with adjusters that they are paid by the insurance company (or an ERISA plan's third party administrator). They have a vested interest in denying your claim. The insurance companies are running a business, and they only make money when they collect more money in premiums than they pay out in benefits. That means they are looking for reasons to deny your claim.
When you speak with someone from the insurance company, they are taking notes on what you say and how you sound. These notes are kept in their computer with other information on our claim and can be used as evidence against you from your initial application all the way to a lawsuit. Even if you are "on claim" (being paid benefits on a monthly basis), the claim administrator will examine your statements. If you say something that indicates that you might have the capacity to work or something they might think is inconsistent with what you have said in the past, they will use that as a reason to deny your claim or cut off your benefits or to step up their investigation of your claim.
Simple statements about what you do during the day are recorded in the insurance company's logs. For example, if you mention that you enjoy sewing, your insurance company may allege that you are capable of sedentary (sitting) work. Another example would be that you mention you are looking into taking online classes. Even if you have not started the actual classes, the insurance company may try to use this to deny the claim, saying that you are capable of work activity.
Therefore, when speaking with your claim adjuster or adjudicator, do not speak with them as if they are a friend, no matter how nice or sympathetic they may be. You should be polite and respectful, but you should also be aware of what information you are providing. Be careful, because everything you say is on the record, even if you think it does not pertain to your claim.
REMEMBER: THE CLAIM ADMINISTRATORS AND INSURANCE ADJUSTERS ARE NOT YOUR FRIEND. AN INSURANCE COMPANY IS ALWAYS LOOKING FOR REASONS TO DENY YOUR CLAIM.
Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. For assistance with your Long Term Disability claim, ERISA Disability benefit claim, Social Security Disability claim, or Veterans Disability compensation or pension claim, call Disability Lawyer John Tucker at (866) 282-5260.
