7 Strategies Used by Long-Term Disability Insurance Providers to Cease Benefit Coverage

When facing a long-term disability, the last thing you need is an insurance company trying to strip away your benefits. Unfortunately, it’s a common scenario many policyholders face. Insurance companies employ various strategies to deny or terminate benefits, which can severely impact the policyholder’s financial stability and well-being.

Here are seven common tactics used by insurance companies and how you can protect yourself:

Employing In-House Medical Reviewers

Insurance companies often rely on their in-house medical professionals to review your case. These doctors and nurses work for the insurer, leading to a conflict of interest. Their reviews are frequently biased, focusing on finding reasons to deny benefits rather than genuinely assessing your condition.

Example: A claimant with chronic pain might have their condition downplayed by an in-house reviewer, leading to a benefits denial despite substantial medical evidence.

Impact: This tactic can leave policyholders without the financial support needed for treatments and daily living expenses.

Solution: Insist on evaluations by independent medical professionals and ensure all medical records comprehensively document your condition.

Contracting Peer Reviewers

Insurers may hire external medical professionals to conduct “peer reviews.” These reviewers do not examine the claimant directly but provide opinions based solely on medical records. These reviews often result in denying or terminating benefits.

Example: An external reviewer may question the severity of a mental health condition, suggesting that the claimant can still perform certain job functions.

Impact: This can lead to unjust benefit termination, exacerbating the claimant’s health issues due to stress and financial strain.

Solution: Challenge peer review findings by providing additional medical documentation and seeking second opinions from unbiased experts.

Demanding Objective Evidence

Insurance companies often demand objective evidence for conditions that aren’t easily measurable through tests like MRIs or X-rays, such as depression or fibromyalgia. They use the lack of such evidence to deny claims.

Example: A claim for fibromyalgia could be denied because there’s no definitive test to diagnose it despite the claimant’s significant pain and limitations.

Impact: This tactic can leave policyholders without support, worsening their condition due to lack of treatment.

Solution: Ensure comprehensive medical records and expert testimonies are provided to substantiate your condition and its impact on your ability to work.

Redefining Disability

Most disability policies change the definition of disability after one or two years, shifting from being unable to perform your own occupation to any occupation. Insurers use this shift to deny ongoing benefits.

Example: A surgeon may qualify for benefits initially but later be told they can perform sedentary work, even if they are unqualified for such roles.

Impact: This can force individuals into unsuitable jobs, exacerbating their disability and financial challenges.

Solution: Gather vocational expert reports that demonstrate why you cannot perform any job due to your disability.

Independent Medical Examinations (IMEs)

Insurers may require claimants to undergo IMEs with doctors chosen by the insurance company. These doctors might not thoroughly review all medical records and can provide biased opinions favoring the insurer.

Example: A claimant with multiple sclerosis might be examined by an IME doctor who overlooks the severity of their symptoms, leading to benefit termination.

Impact: IMEs can result in unfair benefit denials based on incomplete or biased evaluations.

Solution: Document all interactions during IMEs and seek immediate second opinions from your own medical providers.

Surveillance

Insurance companies sometimes hire private investigators to conduct surveillance on claimants, attempting to catch them performing activities that contradict their claimed disabilities.

Example: A claimant with severe arthritis might be filmed carrying groceries on a good day, leading to accusations of fraud and benefit termination.

Impact: Surveillance can cause tremendous stress and lead to unfair accusations, further harming the claimant’s health.

Solution: Be aware of your surroundings and consistent in your behavior, and explain any discrepancies in your abilities to your doctor.

Mental Health Condition Limitations

Many policies limit benefits for disabilities caused by mental health conditions to 24 months. Insurers might argue that a disability is primarily mental to cut off benefits early.

Example: A claimant with both PTSD and a physical injury might find their benefits terminated because the insurer claims the disability is due to PTSD, which has a 24-month cap.

Impact: This limitation can leave claimants without critical financial support, worsening their overall health.

Solution: Ensure that both the physical and mental aspects of your condition are well-documented and challenge any attempts to misclassify your disability.

How Monahan Tucker Law Can Help

At Monahan Tucker Law, we understand the emotional and financial distress caused by benefit denials. Our team stands up to insurance companies and ensures you get the benefits you deserve. Here’s how we support our clients:

• Comprehensive Appeals: We prepare thorough appeals with new medical and vocational evidence to counteract benefit denials.
• Direct Lawyer Interaction: You will speak directly to your attorney, ensuring personalized attention and guidance.
• Legal Representation: If benefits are wrongfully terminated, we handle all lawsuits and future interactions with insurers.
• Track Record of Success: Our firm has achieved victories against major insurance companies, securing the rightful benefits for our clients.

Get In Touch

Navigating the complexities of disability insurance claims can be overwhelming, but you don’t have to face it alone. Contact Monahan Tucker Law today to discuss your situation and learn how we can help you fight for your rights and regain your peace of mind.