Americans grow up with an overwhelming work ethic originating all the way back to influences of our founding fathers brought to this country by the Puritans, Quakers, and other protestant groups. For this reason, Americans often define who they are by what they do for a living. Work ethic is in our culture; we feed it with free enterprise and capitalism and expect everyone to pay their own way.
Unfortunately, when an individual can no longer “work” due to a disability and files a disability claim, he/she is often made to feel embarassed, shameful, guilty, and a malingerer. In an effort to “convince” the insurance company the claim is legitimate, insureds make the mistake of giving the disability insurer more information than it needs to investigate the claim. This nearly always results in a denied claim at some point.
It is important for all insureds to understand that it is to the advantage of the insurance company that you “feel bad” about not being able to work. No claims handler, for example, is going to try and make you feel better because you are out of work and costing the company money. If the insured is distraught and overwhelmed with guilt for having to file a claim, it is more likely the insurance company will be able to get that insured to say things it can use to deny benefits. For example, don’t tell the insurance company “I feel bad because I can’t work.” No amount of convincing on your part will change the presumption of malingering by the insurance company.
Disability insurance employees do not “feel sorry for you”, nor is it their job to provide counseling to help you feel better about not being able to work. In fact, just the opposite; if an insurance company can keep you talking, sooner or later you will reveal something adverse to the claim. This is the precise purpose of field representative visits.
Insurance companies cannot hold against you what you do not say or write. While it is important to provide the disability insurer with truthful information it needs to investigate the claim, no insured is required to provide information about hobbies, laundry, income or health of family and friends, church or religious activity, romantic or sexual preferences or acts, babysitting, visits of friends or relatives etc. These topics are purposely designed to encourage insureds to descibe “at least sedentary work ability.” Once said, claims are denied faster than a New York minute.
Here’s a few real life Unum examples: (Unum seems to engage in this more than other insurers.)
Unum denied a claim of a 50-year-old executive diagnosed with heart disease because he told the claims handler on the phone his wife was recently diagnosed with breast cancer. Unum claimed he went out on disability so he could help his wife through “her ordeal.” (Issues of secondary gain.)
Unum also denied a claim because the insured told the claims handler she was babysitting for her daughter’s children in her home. (Ability to work a sedentary job.)
Unum denied a claim when a young insured revealed she was having fertility treatments and was trying to have a baby.
Unum denied the claim of a paralegal because she sent 5-6 page typed letters to Unum explaining why she was disabled. (Gee…if she can type 5-6 page letters, then she can certainly do her job.)
Here are some suggestions for insureds:
- Answer only the questions asked, nothing more. Do not contribute additional information beyond what is asked. You don’t have to justify why you are disabled.
- Don’t apologize to the insurance company for not being able to work, and avoid telling the insurance company the story of your life. Most disabled persons DO NOT HAVE “typical days”, so don’t try to invent one. You don’t have to convince anyone you have a legitimate claim.
- Avoid expressing emotions such as “I’m really sorry I can’t work”, “I wish I could work”, “Maybe I could try to work in a few months”, ” I tried to stay at work, but I just couldn’t.” None of these comments matter to the insurance company in the long run.
- Never speak with the insurance company on the phone. Insureds should request the claims specialist send all their questions in written narrative form. This way you will have time to consider your answer and you create a written record of your responses rather than allowing the claims handler to “interpret” and document what you say. Keep responses truthful and short. Less is more.
- Never write narratives or letters to a disability insurer explaining why the companyshould pay your claim. Nearly all questions can be answered in no more than two sentences. Always keep responses very brief. As strange as it sounds, writing long letters to an insurance company may give it the impression you need counseling and have a mental rather than a physical claim.
- Defer all questions about medical ”restrictions and limitations” to your physician. These are medical terms which are unique to the insurance company and should be provided by a medical resource. Insureds aren’t qualifed to answer these types of medical questions and certainly responses won’t be consistent every time you’re asked.
- Don’t be afraid to ask “What has this question to do with my policy, or my inability to work?”
Please note – it is the responsibility of the insured to cooperate fully and provide the insurance company with truthful and honest information in the following areas: 1) occupational (job description or employer statement); 2) medical (restrictions and limitations from all treating providers); 3) financial (tax returns or salary and earnings information); and 4) Social Security application and award information.
In addition, insureds and claimants should abide by all duties as outlined in the policy contract such as insurer requests for IMEs, field visits, notice of claim etc. Insureds and claimants do have duties and responsibilities under the terms of the disability contract and should provide the required information when asked to do so.
Remember, “An insurance company cannot use what you DO NOT SAY OR WRITE against you.” Exercise great caution in what you say or write to any insurance company. Less is more. Answer only what is asked, or provide only what is asked for, nothing more.
