What are they doing to me?
Tactic #1:Insurance Company contacts the insured and has what seems to be a very friendly interview regarding the insured day-to-day activities. The insured may note minimal abilities to perform day-to-day activities, but these can be later construed by the Insurance Company to deny a claim by indicating the insured has the abilities to perform these abilities 5 days a week for an eight hour workday.
Tactic #2: Insured is requested to go to an independent medical evaluation (IME) to be examined by a physician. These examinations are not independent. An IME physician may severely discount any injuries or sickness and determine the insured is able to return to work, despite the insured's honest opinion that he/she cannot return to work, and despite the opinions of treating doctors.
Tactic #3: Insurance Company requests the insured to attend a functional capacity evaluation (FCE). An insured may fully exert oneself on a one or two day FCE test and may be unable to perform such physical abilities on a regular basis during a 40 hour week. However, the insurance company may determine the insured has these abilities on a day-to-day basis, despite the fact that an insured may not be able to physically function at the level noted in the FCE during a 40 hour work week. The examiners sometime misinterpret the test results.
Tactic #4: An insurance company may hire an investigation service to videotape the claimant's day-to-day activities. Simple activities, such as, driving, attending a doctor's appointments, or going to the grocery store, could be construed by the insurance company that the insured has the abilities to function in the workforce and may be used to deny a claim for disability benefits.
Tactic #5: The insured is denied his/her claim and may not realize he/she only has a limited amount of administrative appeals. If the disability claim is governed under ERISA, then the insured may only have a limited amount of administrative appeals to submit information to the insurance company. If the insured's disability claim is governed under ERISA, then it is possible that no more documentation may be permitted to be reviewed by a court once a lawsuit is filed. Without proper documentation from the insured, treating physicians, the employer, etc., an insured may not be successful in a court of law in overturning the decision by the insurance company to deny disability benefits.
Tactic #6: Some disability insurance policies may have a two year limitation for disability benefits, if the illness/sickness is related to a mental illness. An insurance company may argue an insured's illness/sickness has a mental component and that benefits are limited to a period of time. However, it can be successfully argued, with the proper legal assistance, that a mental illnesses may be the result of the physical disabling injury and not the primary cause of the disability.