Neuropsychological testingRecent conversations with reliable neuropsychologists suggests that it is more common these days not to provide raw data to insurance companies. According to my sources neuropsychologists don’t have good opinions of insurers who request raw data so that internal physicians can interpret test results in ways that favor the insurance industry.

Currently, it’s customary for insurers to request raw data (actual test results) from qualified evaluators so that insurance MDs can interpret the data differently. Although neuropsychological tests are generally regarded by the insurance industry as objective evidence, those in the industry know differently.

Neuropsyche tests consist of a battery of tests selected by the evaluator based on the patient’s history, diagnosis and probable outcome. Test scores are obtained from the tests themselves and are then compared to normative values consisting of statistical population scores for those in similar groups. Once scores are obtained, evaluators interpret the test results and render summary reports rrepresenting opinions of what the test scores mean. To say that neuropsychological evaluation represents “objective evidence” is a stretch.

The American Psychological Association forbids the transfer of raw data to those who are unqualified to interpret it. Therefore, even when the raw data is provided to insurers the “chain of evidence” must be maintained in order to protect the integrity of the tests. In addition, neuropsyche evaluation cannot be done more than once in a 12 month period. Typically, a baseline test is completed and if appropriate all future test results will be compared to baseline.

The transfer of raw data to insurance companies interferes with the integrity of the data. It is now known that insurers such as Unum and Prudential request the raw data so that it can be interpreted by internal physicians to support business decisions already made to deny claims. Neuropsychological tests are not objective whether they are performed by claimants’ evaluators or internal insurance physicians.

In my opinion and experience, neuropsychological testing is a garbage-in, garbage-out evaluation. Neuropsyche IMEs performed by insurance evaluators often fail to choose the correct battery of tests to determine disabling levels of cognition, brain fog, chemo brain, and many other dementia type illnesses. Although there are collections of tests out there to evaluate fibromyalgia, most insurance evaluators do not test to prove disability, but to discredit it.

Insurance IMEs always include the MMPI-II or a newer version of it misused to evaluate malingering. Therefore, from the onset, insureds and claimants are “set up” by defense neuropsychological evaluations when the correct battery of tests is not administered.

Due to the insurance industry’s corrupt use of neuropsychological data, many evaluators are choosing not to release actual test data from their offices. “I will never, never let that happen”, one client reported her neuropsychologist saying, “I will never release actual test data to an insurance company. The data is misrepresented and results in further psychological damage to my patients.”

It would appear that the insurance industry may have fouled its own process by using neuropsyche raw data to further its own profitability objectives for so many years. What used to be thought of as “objective evidence” is really the result of differing opinions as to what raw data scores actually mean. In short, raw data evaluated by 5 qualified neuropsychologists could result in 10 opinions.

I’m happy to see neuropsychologists smarting up to insurance abuses of the specialty and thinking twice about giving raw data to insurers. My impression is that some evaluators are savvy to the industry’s abuse of the raw data and are anticipating changes on the way preventing the release to insurers.

Friday Q & A

Q&A ButtonCan my Unum disability claim be denied if I refuse to sign an Authorization?

Some disability policies today contain contract provisions requiring you to sign an Authorization. Those that don’t have no authority to deny just because you refuse to sign.

HOWEVER, if you refuse to sign an Authorization prohibiting any insurance company from fully investigating claims, such as obtaining medical, financial and occupational information, it is very likely insurers will deny claims and document, “since you did not sign an Authorization allowing us to obtain information concerning your claim, there is insufficient supportive documentation to pay you.”

Therefore, while Unum does not have the contractual authority to deny solely on your refusal to sign the Authorization (in most policies), eventually the claim could be denied for “insufficient proof of claim.”

DCS recommends to insureds and claimants that they sign Unum’s authorizations. It just isn’t a good conflict to get into, and it is too much of a risk for potential “failure to provide” denials in the future. Not signing a Unum Authorization isn’t a push-back insureds and claimants generally win; and, not signing creates an adversarial relationship and red flag that sets the tone for the remainder of the claim.

I am aware that some attorneys jump right into the conflict by not allowing clients to sign insurance authorizations, and even then the attorneys risk denials for “failure to provide.”( I wonder about that…)

But, in my opinion, due to the Internet and global technologies, insurers already know more about insureds than they might think. Most insureds I speak to still believe there is information they can protect, but again, in my opinion that’s doubtful.

DCS recommends insureds and claimants sign Unum’s Authorizations and live to conflict another day.

Unum wants access to my bank. Should I give it?

Absolutely not. It’s not that Unum’s asking in particular, but people in general should NOT give anyone access to their bank accounts. One mistake on Unum’s part could deplete all of your funds leaving you with a bank error that will take forever to correct.

I am assuming this question is not referring to Electronic Funds Transmissions of benefits. We do recommend that if EFT service is available that insureds take advantage of it.

Insureds tend to forget about ” business best practices” when they file disability claims. I’m sure Unum’s not out there giving outside sources its banking information and neither should you give Unum, or anyone, yours.

Although I have seen authorizations allowing Allsup and Genex access to banking accounts we recommend against that. When you receive your SSDI lump sum, Allsup will immediately remove it from your checking account without verifying with you the amount removed was accurate.

This is not something anyone should do outside of EFT.

Why did the Unum IME physician ignore all of my medical evidence?

There are many excellent posts on this blog regarding the purpose and intent of insurance Independent Medical Evaluations. If you search “IME” from the Home Page you may find good information to help you understand the purpose and intent of insurance evaluations.

The short answer today, however, is that it is not the intended purpose of an insurance IME to fairly assess medical conditions and render accurate reports about anyone’s ability or inability to work. Unum, in particular, hires from IME Networks containing lists of physicians who have a history of rendering reports favorable to its pre-determined business decisions to deny claims.

Insurance IMEs are universally accepted as prejudicial and biased; therefore, your “medical evidence” isn’t even a consideration.

Based on my 13 year experience as a consultant in my own practice, it appears less than 30% of IMEs performed are favorable to insureds. Unum’s percentage is probably less.

What activities can you do while on Unum disability?

While this question specifically asks about Unum my answer relates to all disability claims with all insurers.

DCS, Inc. recommends to insureds and claimants that they not exceed the medical restrictions and limitations provided by treating physicians. If your physician is reporting no lifting > than 20 lbs. then there should never be a time when you lift more than 20 lbs.- not because you have a disability claim, but because lifting greater than a recommended medical restriction might cause injury and pain.

Insureds should be compliant with all of their medical restrictions and limitations. Remember Murphy’s Law. The one time you decide to walk around the Mall for hours is the day Unum’s surveillance team will record it.

And by the way, saying “Yes, I did that, but I paid for it an entire week afterward”, won’t fly to keep your claim from being denied.

I support complete compliance with medical restrictions and limitations, not because insureds have disability claims, but because its common sense medically to do so for one’s health.

Health insurance policyAlthough we don’t hear as much about health insurance claims, denials and non-payment as we do about disability, unresolved procedures and/or laboratory test issues arise when health insurers refuse to pay for certain procedures and begin to bill for treatment everyone assumed was covered by the health policy.

As with disability policies, most insureds never seem to take the time to actually read health policies if in fact they ever had copies of original health plans. Part of the problem is that health insurers tend to “dress up” publications that look more like advertisements than providing information as to what’s covered and what isn’t. Health insurers also print out summary sheets of coverage leaving out information that is generally assumed. After all, who really wants to read a health policy from cover to cover?

Many insureds may be unaware that group health policies are protected under ERISA, and patients are allowed certain disclosure rights. However, getting back to health care policy basics means first obtaining a copy of the health policy describing coverage and making yourself knowledgeable as to what the policy pays for and what it doesn’t.

Recently, a young woman called me about several unpaid bills her heath provider either payed a minimal fee for, or refused to pay altogether. Diagnosed as having toxic mold infections, her doctor suggested that she have certain tests that “could” detect the cause of her symptoms.

After having the tests, which came back positive, she found that her health insurer only paid $15 of a $600+ bill because it was performed by an outside network lab. This patient assumed that because the test results came back positive her health insurer would pay for the procedure. (Medical procedures aren’t paid based on test results as an after-the-fact, “well the test was positive so we’ll pay it anyway” rationale.)

After several months of sending letters back and forth and multiple requests to her physicians for further certification (now, her physicians refuse to take her calls), the health care provider still won’t pay for the tests.

Of course my first question was, “What does your health policy say about paying for out of network tests and procedures, or unapproved lab sites?”

“I don’t know”, she told me, “I don’t even know where my health policy is, or if I ever had one.”

Health insurance policies contain very detailed instructions about how to appeal non-payment or non-covered procedures issues. The appeal process generally involves obtaining clarification and further justification of the non-covered procedure from the prescribing physician, patient notes, test results etc.

On occasion non-payment types of health coverage issues could have been avoided by making a simple call to the provider to clarify what the policy says about paying for the procedure ,or physician prescribed laboratory test.

Although a large majority of health non-payment issues arise due to ICD-9 (10) or CPT coding issues, a small percentage of unpaid health procedures in dispute arise because of the covered patient’s misunderstanding of what’s covered and what isn’t.

In the above example the first step is to obtain a copy of the health insurance policy and see what it says about reimbursement for non-approved or out-of-network lab services. In my opinion, the heath insurer  did not dispute the lab test (since it did pay a $15 minimum fee), but most likely didn’t pay the whole fee because the lab used for the test wasn’t on an approved list. It’s as important to read a health policy as it is to read a policy for disability.

The Affordable Care Act (ACA) brought about the creation and implementation of health care exchanges, but arguably didn’t resolve every billing dispute or billing question concerning health coverage and payment of the costs of treatment.

The ACA created access portals in every state through which individuals and their families, small businesses, and employees can compare, select, and purchase federally compliant health plans and, if they qualify, receive federal assistance to pay for the coverage.

Although the Affordable Care Act makes health insurance more available to those who otherwise couldn’t afford it, insureds should always be knowledgable about their coverage, and in particular, be familiar with the appeals procedures outlined in the policies.

DCS can assist insureds with health insurance issues but the first question I’m going to ask is, “May I please see a copy of your policy?” If there is a valid dispute we want to make absolutely sure we have our “ducks in order” according to descriptions of coverage in the health policy, and are aware of what appeal procedures should be followed.

Friday Q & A

Q&ADo Unum investigators pay neighbors to be able to conduct surveillance from their property?

To my knowledge, “No.” Insurance investigators are prohibited from sitting on adjacent properties without permission, but paying neighbors to allow investigative squatting is generally not an option. Surveillance and Internet “snoop-dogging” is at an all-time high these days, but paying neighbors to sit on their property isn’t one I’ve heard of although I don’t entirely discount it.

Although insureds and claimants tend to view “insurance surveillance” as an invasion of privacy (which it is), they often forget the level of surveillance that’s “out there” in public view anyway. There are cameras at ATMs, supermarkets, parking lots, banks, gas stations, well…..you name it, there’s probably a camera somewhere in the vicinity. As if that isn’t bad, regular people are more than ready to photograph or video anything on their iPhone anytime they want, AND let it go viral!

Surveillance is something US citizens live with everyday and not just because insurance companies want to remove you from the benefits you deserve.

What does my policy mean by “reasonable continuity?”

A few attorneys in California are making a mountain out of the phrase “reasonable continuity” in order to have something to argue about. Even if you research the phrase on the Internet you probably won’t get a clear answer. In my opinion, I think the phrase actually defines itself.

“Reasonable continuity” wording is included in the definition of disability such as, “cannot perform the material and substantial duties with reasonable continuity.” This phrasing suggests that insureds and claimants must be able to perform their own job or occupation as often as would normally be required to meet the employer’s expectations and outcome of the job.

In other words, claimants would be considered disabled if unable to be at work on a sustainable basis, or at least within what would be acceptable of other employees who are not ill. An employee who is absent several times per week is not able to perform the job with reasonable continuity. This is why some medical forms ask the question, “How many times is this patient likely to be absent from work?”

To complicate matters, not all jobs require the same “continuity.” One job might require the employee to be at work at least 4 times per week while another job could not be performed with just one absence. Therefore, the word “reasonable” is relative to the actual job expected to be performed.

“Reasonable continuity” wording is beneficial to insureds and claimants since absence from work clearly means employees are unable to sustain work on a regular basis, or with “reasonable continuity.” The burden of proof for disability is much easier to prove than if the wording was omitted from the contract.

Can I get FMLA and SSI at the same time?

I think you may be misunderstanding what the Family Medical Leave Act is and how it works. FMLA is a federal law that requires employers to hold positions and continue to provide health, life and other benefits for a period of 12 weeks. FMLA is unpaid leave and runs consecutively with SSI, SSDI, or private disability.

SSI is a federal benefit paid to poverty level US citizens when certain financial guidelines are met. Employees who leave work will be eligible for FMLA (job and benefit protection for 12 weeks), and may also qualify for SSI while waiting for SSDI to be approved.

Can my spouse whistle blow to the IRS?

In today’s world anyone can whistle blow to anyone. Chances are there will also be iPhone videos or photos and/or paperwork to back up the complaint. Ex-spouses and spouses have also been known to call insurers as well to make trouble with private disability benefits. Anytime a complaint is made by a spouse claims handlers are required to follow-up to determine if it’s credible or not. Spousal complaints do raise red flags with insurers that never seem to go away.

I appealed my own Unum claim. Is it a good sign that they are extending my review time?

Not necessarily, and probably not. Extensions of ERISA timelines can mean Unum is conducting surveillance, or having information reviewed by outside sources that also can’t meet deadlines. Extensions can also mean Unum is negligent and your appeal sat on someone’s desk without action, or it can mean the claim is being put through a myriad of roundtables and internal medical reviews to obtain back-up to keep claims closed.

Unum seems to be hiring JDs as Appeals Consultants who will also review the appeal denials to determine if Unum “can get away with not paying them.” I don’t see multiple ERISA extensions as necessarily a good thing, but unfortunately there is no agency who will help you enforce the 90-day timeline outside of litigation.

Since you are appealing Unum’s denial decision on your own you can certainly question why Unum is extending beyond 90 days or can’t meet ERISA deadlines.

This issue is really a Catch-22 situation. While you WANT Unum to take the time it needs to review your information fairly and objectively, you also need to have a timely decision. However, there is nothing you can do outside of litigation to challenge Unum’s own internal review timeline.

My advice to you is to contact an experienced ERISA attorney if Unum stalls or delays your appeal. If you’d like the name of one, please contact me and I’ll be happy to make the referral.

Can GENEX help me with my SSDI claim?

DCS, Inc. does not recommend the use of GENEX, Allsup, or Advocator Group for the reasons mentioned on this blog in several previous posts. Please do a search from the Home page and you will find the answers you are looking for. We do not recommend you go that route. If you have any questions about this, please give me a call.

New ChapterHaving spent the last week in “private mode” it occurred to me that Lindanee’s blog in lock down serves no educational purpose and certainly does not uphold my longstanding philosophy that insureds and claimants have a right to information about the private disability claims process and state agencies influenced by special interests and big business such as Unum.

Although the Maine AG’s office wasn’t pleased with my article “…Sleeping with Unum”, the moment the AG picked up the phone to ask Unum for its opinion, the door was opened to public scrutiny and criticism. After all, I think it’s important for insureds and claimants to know who’s running Maine’s government offices and how state government, particularly one without checks and balances, is influenced by corporations with conflicts of interest.

My guess is that if the Maine AG’s office is a Unum power base, it wouldn’t be too far-fetched to suggest the Department of Insurance is also under Unum’s thumb. Although the multi-state settlement agreement left the door open for further monetary fines for Unum’s continued wrongdoing, Maine has never pursued further investigations to determine if Unum is compliant or not. It’s my understanding Unum now has an entire department to counter state Conduct Market Examinations – or to say it another way, hide its dirty laundry.

Although Unum “smacks down” many of its own insureds and claimants the company is extremely “sensitive” to getting “smacked back” and is known to retaliate against those who act contrary to Unum’s profitability interests. It is discouraging that the Maine AG supports that agenda, although we now know that it does.

A recent phone conversation with yet another member of the legislature proved that he was also unaware of the unfettered power the AG has to allow special interests to influence its decisions. After a brief call to the Speaker of the House, it was verified that the legislative ethics committee has no jurisdiction over the Attorney General and perhaps a committee should be formed in the next session to offer Maine citizens a method of complaint should the AG engage in abusive tactics. It was also suggested that Maine citizens file complaints with the Overseer of the Bar since AGs are attorneys first and state employees second.

Unfortunately, the Maine legislature’s focus is to impeach Governor LePage and will likely spend most of its efforts throwing stones toward Republican opposition. In any event, Maine remains a hotbed of corrupt government with Unum pushing the buttons in the AG’s office. 

In the meantime, Lindanee’s Blog will continue to provide insureds and claimants information they need to protect themselves against unfair claim denials and bad faith. I will continue to offer consulting services, and look forward to writing my book while on vacation next month.

There’s more than one way to skin a Unum cat.

I was harassedUnum’s management of Short-Term Disability (STD) can go well, but also very wrong. In fact, I’ve often referred to Unum’s STD as a “hop n’ skip” process of approving benefits for 2-week intervals until the maximum 26 weeks of benefits have been paid. Although STD is expected to be a period of relatively short duration, Unum manages STD as if all claimants are able to go back to work even when they are unable to do so.

Unum also presumes that there are new patient notes every two weeks and that STD claimants consult with physicians that often. In truth, not even STD claimants are required by their physicians to show up for office visits every two weeks. Treating physicians are placed in positions of having to provide “proof of claim” every two weeks; if Unum doesn’t receive the information it harasses doctors and won’t pay benefits until new information is received.

Mind you, this is the “two-week hop n’ skip” I mentioned earlier that keeps claimants sitting on the edge of their chairs wondering if they will receive another check. One thing Unum STD claimants can do is to discuss Unum’s STD procedures with their physicians and ask office managers to automatically fax new patient notes to Unum. But, be prepared.

Unum’s STD is also chaotic and disorganized most of the time and benefit payment delays often result when Unum alleges “we didn’t get it.” Although insurers are permitted to obtain medical information directly from physicians, it might help for STD claimants to obtain any new information and send it to Unum via US Priority Mail Signature Confirmation.

Here is a true story taken from Consumer Affairs dated September 11th:

“All I have to say is that Unum has caused me so much stress that I regret having surgery. They have threatened not to pay my benefits every 2 weeks. I was injured at work and was not my fault but I continue to worry more about survival than recovering. I am a divorced mother of three and the constant worry that they have put me through is unfair and I feel beyond harassment. I just checked for this week’s deposit and I only got half. Why??? My children depend on me. I need a lawyer.” (Posted from Consumeraffairs.com)

Short payment interval STD does in fact cause insureds to be fearful and harassed. Imagine – every two weeks a Unum rep is on the phone with you and your doctor demanding updated medical information, not to mention at least several letters in the mail requesting the same.

Whether insureds realize it or not, their lives are affected by Unum almost on a daily basis. Some decide to go back to work sick and unhealed just to rid themselves of Unum’s constant contact. I sympathize with STD insureds who describe Unum’s harassment that never seems to end.

It used to be that since there were no financial reserves associated with STD claims, most insurers just paid STD without much hassle. However, in recent times employer Plans that transition from STD to LTD pose potential future losses paying claims to age 65. The thought at Unum (at least it used to be) was that the sooner claims could be denied the less likely a more expensive LTD liability would have to be paid. Many times it’s the more expensive LTD claim Unum wants to deny not the STD.

The best thing STD insureds can do to help themselves is to work with physicians and staff by informing them of the process and ask that they fax new patient notes and other records to Unum as quickly as they can. Alternatively, claimants can obtain new patient information and send it directly to Unum with confirmation of receipt.

And, by the way, employees who are injured on the job and file worker’s compensation claims may not be entitled to STD. It is possible with a work injury to skip the STD, file for worker’s comp and LTD that will be paid with a WC offset.

Friday Q & A

Q&A ButtonWhy can’t patients see psychotherapy notes?

Actual psychotherapy notes are written by therapists as reminders of patient consultations. The therapist may include notes about observations (affect), potential diagnoses, reactions to the patient, and conclusions resulting from therapy.

Writings of therapy sessions are for THERAPIST EYES ONLY and aren’t written to support, or not support, disability claims either. This is perhaps why many therapists are either not writing consultation notes, or refusing to send them to any outside third parties.

Patients are not given access to therapy notes because what is written in the notes can be upsetting to mental health patients. In most instances mental health providers who choose to release mental heath records send them directly to insurers. Patients who are already emotionally impaired should not be provided with information that will cause more emotional trauma.

It’s my opinion that this is the best course of action for those receiving counseling and behavioral therapy.

Does my therapist have to send my insurers actual psychotherapy notes?

No, they don’t. Many therapists today are refusing to provide actual therapy notes to insurers because the purpose of the notes isn’t to support or discredit disability claims. The real intent of actual psychotherapy notes is to provide personal reminders to therapy that actually took place; therefore, many psychologists consider patient notes as personal property.

Having said this, all insureds and claimants receiving therapy must provide mental restrictions and limitations to insurers if, in the opinion of their therapists, they are unable to work. Usually this can be provided to insurers in “summary form” by filling out behavioral mental and nervous evaluation forms.

Prudential in particular is particularly insistent that they can’t pay mental health claims unless psychotherapy notes are released. Since Prudential continues to make claim decisions based on RN reviews, it makes sense that “psychotherapy notes” could coach RNs allowing them to “snatch” key phrases favorable to Prudential while ignoring all other remarks favorable to insureds.

My opinion is that the value of therapy is brought into question when insureds and claimants are aware psychotherapy notes will be sent to insurers. Claimants are less likely to share personal and private information in therapy that is essential for the success of behavioral or modification therapy.

In the end, the decision to send psychotherapy notes rests between the therapist and patient. But, it’s my observation most therapists today reserve the right not to release actual psychotherapy notes to any outside third-party.

Can my attorney make me sign a settlement agreement that isn’t fair?

My first reaction to this question is “No”, neither your attorney nor the insurance company can make you do anything you do not want to do. However, the truth is probably closer to “well it depends.”

Any attorney’s course of action should be discussed in advance so that clients have a clear idea as to what may happen to the case (claim) in the future. While I’ve had some experiences with attorneys who look to bail out of cases when it turns sour by recommending settlement, as a consultant I also know that at times the best interests of an insurance client are to accept settlement and move on.

It also depends on what you mean when you say “unfair.” Insurance settlements are based on percentages of net present value and do not represent the full value of claims anyway. Unum, for example, rarely settles for more than 80% of the financial reserve, so they make at least a 20% profit on any claim that’s settled.

Settlements made literally “on the courthouse steps” tend to be more generous, but there are those who suggest insurance settlements aren’t fair to begin with. Therefore, the short answer to your question is “No” attorneys can’t make you sign an unfair insurance settlement, but they can drop your case with adequate notice, and leave you without benefits or a settlement.

Perhaps the better answer to this question is to encourage you to improve discussions you have with your attorney so that both of you can have a “meeting of the minds” about what you want to do and how much you are willing to accept. Sometimes better communication helps you to understand why your attorney is recommending certain courses of action.

Unum reduced my benefit without SSDI actually being approved. Can it do that?

Actually, yes they can. If you refuse to apply for SSDI, or do not provide proof that you’ve applied, Unum may estimate any potential award in the future and begin to offset (reduce) your benefits. If you read your policy carefully you will find out what Unum can do if you do not abide by the policy provisions requiring you to apply for SSDI.

If your policy also offsets for dependent awards then you should be aware of that fact and also apply for dependent SSDI. Unum has a habit of reducing benefits for primary SSDI (insureds), and also for dependent awards even though claimants didn’t know to apply for dependent awards in the first place.

Claimants should also be aware that policy provisions today often describe “other income benefits received, or entitled to be received”, meaning if you are entitled to a lump sum pension distribution but do not take it, benefits can also be reduced.

Please pull out your LTD policies and read the section on “OTHER MONTHLY INCOME” carefully so that you will have a better understanding of what Unum can do and what it can’t.

What’s the deal with my insurer offering me “Accident” and “Critical Illness” insurance. Do I really need it?

There is a trend going on now with disability insurers attaching riders or separate “indemnity” policies to group disability insurance. Since group Plans contain increasing adverse provisions, in my opinion group insurers are marketing indemnity plans to bolster sales of group disability to employers.

Accident and Critical Illness insurance pays a fixed per diem amount for injuries resulting from accidents. Critical Care or Illness insurance also pays fixed amounts directly to patients when diagnosed with a critical illness. There is an underwriting process for Critical Care policies and not everyone is accepted depending on medical histories for potential illness.

From the literature I’ve been reading advisors are often recommending that claimants self-insure for accidents and critical care through Health Savings Accounts (HSAs) and personal accounts set up for that purpose. My read on the trend for employers to offer such insurance is that they are being “over sold” on products to encourage them to buy group disability which isn’t a good buy at all.

Accident insurance is often misunderstood by many who do not understand the policy only pays for injury resulting from an accident. Although this topic could be an entirely different post, it should be noted insurers decide what constitutes an accident.

The example I use is what happens when an insured drives his car into a post (an accident) and then dies of a heart attack? If this insured has a history of heart disease the accident insurer will allege the driver had a heart attack first (sickness) and then drove into the pole (accident).

Situations like this can get really crappy with accident insurance.


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