Navigating the Insurance Claim Maze


Navigating the Insurance Claim Maze

Navigating the Insurance Claim Maze

Over the years we have seen every conceivable problem that can arise with a long-term disability claim. The most common issues raised by insurers include questions regarding the medical diagnosis and prognosis, disputes over impairments and their effect on a claimant’s functionality and disagreements over an insured’s occupational duties.

Individuals filing their own claims do not have the benefit of being able to distance themselves from the claims process. Moreover, they often fail to appreciate the importance of the many loopholes, pitfalls and details built into all insurance policies. These realities can pose significant problems.

For example, claims adjusters will ask for a narrative descriptions of “all of your occupational duties.” Some companies will use a claimant’s answer to this question to assert that because the insured can perform some of their occupational duties he or she is, at most, partially, not totally, disabled.

Policy benefits calculated on a Residual or Partial disability rather than a Total disability basis can not only result in lower monthly payments, but under many policies, these payments end at age 65, rather than continuing for the lifetime of the insured.

In addition, insurance companies will sometimes use an insured’s acceptance of Residual payments to permit a contractual or procedural time limitation to run out, so that by the time the insured realizes the financial effect of having accepted such payments it is too late to challenge the situation.

There are dozens of other traps for the unwary in the filing of a disability claim. And finding one’s way through the maze of obfuscation can be like finding one’s way out of the wilderness without a compass.

We have the maps.