Our last post discussed some of the ways
the insurance company will attempt to gather your personal information
once you have submitted your disability claim. In this post, we will
discuss some of the other methods insurance companies use to evaluate
your disability claim.
THE INVESTIGATION CONTINUES
In addition to conducting interviews and
surveillance to learn about the details of your personal life, the
insurance company will conduct several other evaluations as part of its
investigation of your claim.
Medical Evaluation
The disability insurance company will use the Authorization you signed
to gather all of your medical records. An in-house medical consultant
(or an “independent” consultant that only works for the insurer) will
review your records and decide if there is enough information to render a
decision. The medical consultant may call your treating doctors
directly to discuss your claim without your knowledge, or may recommend
that you undergo an Independent Medical Examination (IME). Usually, a
medical consultant will order an IME when they think they can
demonstrate a discrepancy or inconsistency in your medical records.
If your disability insurer requires you to participate in an IME, you need to remember that the
examiner is someone chosen and paid for by your insurance carrier, and
is hardly “independent.” You should not use absolutes, like “never” or “always,” and you should
not exaggerate your symptoms. You should also consider bringing a witness
along to take notes of everything that is said and done. Doctors and
experienced disability lawyers generally make the best witnesses, as
they will have the best sense of what information is relevant and should
be recorded.
Occupational Evaluation
The claims manager will review the information you provided about your
former occupation to determine what your job duties were, and whether
you can still perform those duties. For dentists, the claims manager
will normally request CDT codes.
Remember, under the terms of many policies, if you listed several duties
on your initial claim forms, the disability insurer only has to find a
single activity that you can still perform in order to deny or reduce
your disability benefits.
Sometimes, the disability insurance
company will have a vocational or occupational consultant review the
information and provide a report as well. If you listed multiple
occupations in your initial claim forms it will be much easier for the
insurance company’s vocational consultant to determine that you are not
disabled. For example, under the terms of many policies, if you worked
part time as a dental instructor at a dental school at the time you
filed for disability benefits and your disability does not affect your
ability to teach, your benefits will be denied or reduced because you
can still perform the duties of one of your occupations.
Not surprisingly, the disability
insurers’ vocational report will often seem biased towards denying
coverage. An experience disability lawyer can arrange for an independent
vocational expert to prepare a report to rebut the disability insurance
company’s vocational report.
Financial Evaluation
The insurance company will request copies of your profit and loss
statements (if self-employed) or pay stubs (if you worked for an outside
employer) as well as your tax returns. The claims manager, or sometimes
a financial consultant, will review this information to further
determine what your job duties were and if you are receiving income from
jobs or activities other than your primary occupation.
The insurer also uses your financials to
see if you might have some secondary motive for filing a disability
claim, such as trying to escape an unprofitable business. Similarly, if
you recently sold your practice, or you were in the process of selling
your practice when you filed your claim, you will likely have a hard time
convincing the disability insurance company that you sold the practice
due to your disability, and not because you wanted to retire.
Continuing Claim Forms
While the disability insurance company investigates your claim, it will
continue to require that you complete monthly claim forms outlining your
activities. It will also require that you submit statements from your
treating doctor every month. Experienced disability attorneys can help
you stay on top of this so that you do not prejudice your claim by
missing deadlines or improperly submitting information.
For more information on the disability insurance claims process, visit our website, www.disabilitycounsel.net or take Ed's CE, Disability Insurance Roulette: Why Is It So Hard to Collect on My Policy?
Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.