Disability Benefit Tip of the Week: How to Talk to Claims Administrators and Insurance Adjusters

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.

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.

Senate Asks Disability Insurers to Turn Over Information About How They Handle LTD Claims

The New York Times is reporting today that Sen. Charles Grassley (R-IA), the senior Republican on the Senate Finance Committee, has sent information requests to 9 Disability Insurance companies requesting information about how they handle Long Term Disability ("LTD") Insurance claims. The 9 companies are Aetna, Cigna, Hartford, Lincoln (who recently bought Jefferson Pilot), MetLife, Prudential, Reliance Standard, Standard Insurance Company, and UNUM. The Senate is apparently investigating the common practice of having all LTD insurance applicants apply for Social Security, even though many do not qualify for Social Security Disability benefits.

Often, LTD insurance policies pay disability benefits when people cannot perform their own occupation, even if they can work in another type of job. This is commonly called "own occupation" coverage. However, Social Security requires that a person show they cannot work in other jobs too. Their system is based upon age, education and work experience, and for many that apply for Social Security Disability, they must prove there is no job they can perform. LTD insurance companies make people apply for Social Security Disability because their insurance policies usually allow they to deduct the amount Social Security pays from the LTD benefit they pay to their insured.

In my experience, each of the insurers which Senator Grassley is investigating have made people apply for Social Security, many of whom would never qualify. The Senator's investigation is geared toward determining whether these insurers are helping to create the huge backlog of cases at Social Security. What is worse, many people get Social Security Disability, and the insurance companies still deny their claims!


Copyright (c) 2008 by John V. Tucker and Tucker & Ludin, P.A. All rights reserved. Any content borrowed or referenced from another source is referenced by citation to the original source as noted in the text above.