Before corresponding with your insurance company, become familiar with the terminology, limitations and exclusions used in your policy, read your entire policy carefully, and follow these guidelines to avoid making statements that may cause you problems down the road. If you feel uncomfortable with the communications or direction of questioning related to a long-term disability insurance claim, contact our office for a claim review and assistance.
- Do read your policy coverage, exclusion and limitations sections.
- Do read your dollar caps and limits.
- Do read letters from your insurer regarding its position concerning coverage for your claim.
- Do review the notes you (hopefully) took and kept from all conversations with your claims adjustor.
- Do review the notes you (again, hopefully) took and kept from conversations with the insurance agent when you purchased the insurance.
- Do determine, based on what you were told by the agent and adjuster, and based on the policy itself, why you believe there should be coverage for your claim, and why you think the amount owed is what you have calculated.
- Do hire your own expert (estimator, appraiser, contractor, medical expert etc.) to provide you with his or her opinions regarding key issues.
- Do write a succinct, factual, statement (letter/appeal) explaining your position. If possible run it by an insurance policyholder’s lawyer before mailing it.
- Do not rely on the policy interpretation opinions of any representative of the insurance company.
- Do not rely on insurance company experts about factual matters (such as the customary and reasonable cost of treatment, the reasonable cost of repairs, the reasonable replacement value of real or personal property).
- Do not shade or exaggerate anything you say in your letter.
- Do not threaten anyone or use hostile, intemperate or abusive language.
- Do not send a cc to the President or other irrelevant luminaries.