Long Term Disability Law BlogAttorneys Helping Disabled Claimants Nationwide

Reason #4 for Disability Denial: The Insurance Company Misleads Your Doctor

The disability insurance attorneys at Dell Disability Lawyers have seen many attempts by insurance companies to mislead a claimant’s treating physician, essentially tricking the doctor into making a statement that gives the insurance carrier a reason to deny the claim. What should claimants do to protect against this? Below are some of the lessons we’ve learned over decades of handling long term disability insurance denials.

The Disability Company May Call Your Doctor at Any Time

One of the main ways in which the disability insurance company can push doctors into making certain statements involves the cold call. Your treating physicians should be aware that the disability insurance company may call at any time – and while it’s important for your doctors to be responsive to the disability company’s queries, this doesn’t mean they should feel obligated to respond on the spot.

During this phone call, the disability insurance company will attempt to discuss your level of functional ability by going through a list of tasks like sitting, standing, and walking. For each task, the insurance company will ask your physician how much time you can spend on these activities. Unfortunately, the moment your doctor concedes that you’re not so disabled that you can’t sit or walk for short periods, the insurance company will jump to the conclusion that you can perform at least a sedentary job.

But this isn’t what the policy provides. Generally, during the first two years of long term disability benefits, the standard is whether you can perform your “own occupation” – a specialized inquiry into the duties, skills and education required to perform the job you were working before you were disabled. Even if your own occupation is a sedentary one, assessing whether you can stand for 30 minutes or sit for an hour isn’t a fair way to determine whether you can perform your own occupation.

Even after the definition of disability has shifted to ask whether the claimant can perform “any gainful occupation,” this doesn’t mean that you’ll be expected to perform any job; the true definition of “any occupation” is any occupation that you’re qualified to perform based on your education, training, and experience. The insurance carrier will often conveniently omit this definition when asking your treating physician questions, continuing to focus on questions like whether you can sit, stand, or walk for a specific period of time.

Your Treating Physician Should Ask for Questions to Be Submitted in Writing

Because of the lack of candor that so many insurance companies demonstrate on these cold calls, it’s important that you have this conversation with your doctor first. During each scheduled visit, you may want to reiterate to your doctor what you know about the insurance company’s plans so that, when the insurance company calls, your doctor is prepared.

Another thing to discuss with your doctor is that when they receive these phone calls, it’s entirely reasonable to request that the insurance company submit its questions in writing. Not only does this help keep your doctor from making any potential misstatements or admissions on the phone, but it also allows your doctor to answer these questions at their leisure, without facing additional pressure to quickly respond during (or after) a hectic day at work.

Even if your doctor has already taken a phone call from the disability insurance company, it’s not too late to ask the insurance company to send over a written summary. By getting your physician’s statement in writing, you’ll be able to do two things: avoid the inherent “he said, she said” that can come about after an unrecorded phone call, and provide your doctor with a chance to correct or rebut any inaccurate statements.

Because your medical records and treating physician’s statement are the cornerstones of your long term disability claim, it’s important for them to be as accurate as they can be. Dell Disability Lawyers have helped thousands of claimants obtain benefits after a disability denial, and we can help you too. Just give us a call to speak to one of our experienced disability insurance attorneys or set up a free consultation about your disability claim.

Contact Information