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Thursday, January 1, 2009

It's a Bad Economy....Be Wary Talking To Your Disability Insurance Company - Here's a Baker's Dozen Tips for Talking To Disability Adjusters

For some reason, many of my clients believe that the adjuster that works for the disability insurance company paying their benefits is their friend. I know it sounds cynical, but no matter how nice and sweet they are on the phone to you.....THEY ARE NOT YOUR BUDDY! They are just trying to coax information out of you. Remember, adjusters do not get paid to approve every claim. Insurance companies could never make money if they pay every claim. If the upturn in phone calls to my office is any indication, more people are getting denied in this bad economy.

When you make a Short Term Disability or Long Term Disability claim through your own insurance policy or an employer's benefit (ERISA) plan, you need to do what you can to get approved and avoid being cut off.

Here are 13 tips for talking to the disability insurance company's employees:
  1. Ask the adjuster if you can record the conversation. Many of my clients are on so much medication that they cannot remember what they talk about on the phone, so if that is your problem, explain to the adjuster or investigator that is why you want to record the call.
  2. Speaking of medications, make sure you tell the adjuster about the impact of your medications and their side effects. Give examples. You should also make sure that your doctors are recording this information, because a lot of adjusters will not just believe you...they need to see it in your medical records.
  3. No matter how nice they are to you, do not volunteer information when answering their questions. Just answer their question. If they ask you, "Do you drive?" The answer is "yes" or "no," NOT "Yeah, I have a 1968 Mustang that I restored.
  4. Do NOT speak in absolutes. For example: never say, "I cannot sit" unless you truly can never sit down. Instead, say explain how long you can sit before you have to move positions because of pain, and then you have to lay down after so many minutes, and so on.
  5. Do not tell them about your sexual dysfunction unless it relates to your job (and it almost certainly doesn't), because they do not care. If it relates to your depression, maybe tell them, BUT keep the next tip in mind....
  6. Be wary of talking about depression if you have serious physical problems that keep you from working, because many disability insurance policies have limited pay periods for depression and anxiety. Your adjuster may try to classify your claims as a "mental or nervous" claim to cut off your benefits or shorten how long you can get paid.
  7. Give examples to bring your limitations to life. Instead of saying, "I have back pain," consider something like this: "My back pain is constant. It changes in intensity. When I get up in the morning, sometimes I cannot straighten upright. It is painful to sit on the toilet, but more painful to get up, and last week I actually got stuck sitting on the toilet and I needed my wife to help me get up....that was so embarrassing. It takes me 20 minutes or so to get moving in the morning, but even then I can't bend over to tie my shoes...I had to have my son tie my shoes for me, and now I bought these velcro shoes......" You get the picture. Make a mental picture for the adjuster so they realize how limited you really are. It works much better than "I have back pain."
  8. Make sure the adjuster has all of your medical records. Ask them. If they don't, offer to get them for the adjuster. Then, you go get them, and read them before sending them in, so you know what the adjuster is looking at.
  9. Ask the adjuster if they need anything else for your file. The last thing you want is for your claim to be denied because you did not send them something which you did not know they needed.
  10. Do not offer to go to a doctor that the adjuster picks for you. 9 times out of 10 they will pick a biased doctor off a list of dependable doctors they use all the time to write reports shooting down disability claims.
  11. Don't give details about where or when you go outside of your house. They will use this information to set up surveillance on you.
  12. NEVER tell an adjuster that you "don't go out." Of course, you go out. When they get you on surveillance going to the store, they just caught you in a lie. Lying is the worst thing that can happen to your claim.
  13. If someone knows about your problems other than your doctors, tell the adjuster who they are and their phone number and ask them to call that person. You should tell your friend ahead of time that you will be doing this, and tell them to follow the previous 12 rules. Make sure your friend understands that their role is to help you explain your disability, so the best thing they can do is to give real-life examples of the times they have seen you have problems. Ask the person what they remember seeing, and if they can describe significant problems, then tell them that is what they want to talk about if they are called.
BONUS TIP: If you have an attorney, tell the adjuster they may only speak to your attorney about your claim. If they have to interview you, do it at your attorney's office. If you do not have an attorney and your claim is being paid, consider hiring an attorney just to make sure you don't to anything to cause your claim problems. It will not be as expensive as you think, and it could save you thousands or tens of thousands of dollars if you avoid getting cut off.

In tough economic times, more and more disability claims are being denied and more disability claims are being terminated. Be careful about how you talk to the adjuster that calls you. They may want you to think they are your friend, but keep in mind who pays their salary. They will get fired if they pay every claim. Don't be the person whose claims lets them save money for their company.

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.

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