Articles Posted in LongTerm Disability (LTD) Insurance

Surveillance is a common tool insurance companies use to gather information about long-term disability claimants. It can feel creepy to know the insurer may scan through your Facebook posts, run a background check on you, or even hire an investigator to follow you. Here are some common types of surveillance used, and advice about surveillance for anyone on disability.

Three Common Types of Surveillance

An insurance company may use different kinds of surveillance depending on how much money it is willing to spend to investigate a claim, what kind of activity it expects to uncover, and the type of disability.

Most people with long term disability (“LTD”) insurance obtain that coverage through their employer. Thus, most of us are stuck with whatever insurance company and policy our employer chooses to purchase. And while you might think to yourself, “they’re all the same, so who cares which insurance company my employer decides to go with,” nothing could be further from the truth.

LTD insurance policies vary widely depending on which insurance company is issuing the policy. Some companies offer good, comprehensive coverage that treats every type of disability more or less the same. Under these policies, regardless of whether your disability is due to physical or psychiatric reasons, you will be paid LTD benefits as long as you remain disabled under the terms of the policy.

Most LTD policies, however, will differentiate between physical disabilities and psychiatric disabilities. If your disability is “due to” a mental and nervous condition, or worse yet simply “caused or contributed to by” a mental and nervous condition, most insurers will only pay you LTD benefits for a maximum of 2 years (versus paying until age 65 for a physical disability). This distinction provides LTD insurance companies with one of their favorite tactics: They will cut off benefits for people under the 2 year limitation by arguing that while you might have some physical problems, the real reason you can’t work is because you’re suffering from depression/stress/anxiety.

Long before I became a lawyer, all the way back in childhood, I hated when people spoke in absolutes. For those who don’t know, speaking in absolutes is using all or nothing terms like: always/never; best/worst; everybody/nobody; can’t; nothing/everything; all the time; all/nothing; constantly; definitely; etc. I dislike absolutes because while on the surface they appear to make a message stronger (“this always happens to me” or “my mom’s cooking is the best”), they actually do the opposite by weakening your credibility.

Does anything happen “always”?

Think about it. Does anything happen “always”?  Can you definitively say there’s no one on the planet who cooks better than your mom? Of course not! But in addition to saying something that you can’t prove, you have also opened yourself up to allow people to be able to prove – very easily I might add – that you are a liar. And once they can prove you lied about that one thing, they can then turn around and use that lie to cast doubt on everything else you say.

As you probably know, insurance companies are masters of fine print. You may think you have coverage for a condition or injury under your insurance, but when the worst happens, you may find out that you weren’t actually covered after all. Or, you may be covered, but you didn’t have as much coverage as you thought you did.

You can’t always protect yourselves from these gotchas. Many of us have insurance through our employers, and we don’t have power to negotiate the terms of those policies.

However, you can still avoid nasty surprises by reading the fine print in advance. Medical insurance is the type of insurance most people are familiar with, and while you don’t need to know your entire insurance policy by heart, you should know the basics of calculating your benefits – i.e., what your deductible, coinsurance, copay, and out-of-pocket maximums are.

Bipolar Disorder, a brain based disorder, causes unusual shifts in mood, energy, activity levels, as well as the ability to carry out day-to-day tasks (National Institute of Mental Health). Bipolar Disorder is a serious mental illness that affects a great many Americans every year. Kantor & Kantor has worked with many clients who suffer with Bipolar Disorder, and such clients are often affected in a way that is life altering and debilitating. Unfortunately, it is not uncommon for these clients to face many obstacles and complications when making a claim for long term disability benefits (LTD) for Bipolar Disorder.

Why are these Long Term Disability claims so difficult?

The first issue that can arise is difficulty in proving that you are disabled (under the terms of your long term disability policy’s definition of disabled).  While you and your doctor both know that you are no longer able to work, meeting a policy definition of disability takes more than just that knowledge.  Unlike a back condition or an autoimmune disease, which can be shown through objective measures, objectively establishing that you have disabling Bipolar Disorder can be tricky. Typically, the diagnosis is made by a therapeutic psychologist. The condition is then treated medically by a prescribing psychiatrist, as well as through therapy with a clinical psychologist.  Thus, there really is no lab test or other objective measure to prove you have the condition.  Your treating providers’ diagnosis, based on their examination and treatment of you, is the objective proof – but you must have their help in getting that information to your LTD carrier.

At the time of the denial, it is customary for claim representatives to tell insureds that they will have an opportunity to appeal the denial and that the appeal will be a “fresh look” at the evidence in the file.  Recently, we here at Kantor & Kantor have seen a new trend with some insurance carriers when there has been an initial denial of benefits.  Some carriers are now providing insureds with a one or two page “appeal form” to be completed by the insured for the appeal.  This is misleading and may actually prejudice the insured when completing the appeal.

As discussed in other posts on this website, the appeal to the insurance company is perhaps the most important part of a claim prior filing a lawsuit.  It is the only opportunity for an insured to ensure that all of the evidence supporting his or her claim is in the insurer’s claim file.  As such, an insured needs to include all medical records and testing documenting his or her impairments. If it is not included within the insurer’s claim file at the time of the final denial of the claim, it is very difficult, if not impossible to persuade a trial judge to consider the evidence.   Thus, the mere completion of an appeal form, without the additional documentation, may cause an insured to believe that a few sentences, “explaining” the disability, may cause an insurance company to overturn its decision.  In truth, it will not.   The insurance company will deny the claim on appeal and its claim file will be incomplete, without the evidence that should be included to prove disability.

The insured should not be misled into believing that completion of a simple form will be sufficient to overturn the decision on appeal. The insurer’s claim file should be obtained to review the evidence in support of the denial and the denial letter should be carefully scrutinized. Once this is done, an appeal should be thoroughly prepared to rebut the insurer’s evidence.

Posted by: Beth A. Davis

If you have a long term disability claim through a policy provided by your employer, ERISA most likely governs that claim. As such, if your claim is denied and you have to pursue your benefits, there are very specific rules and regulations about how – and sometimes whether – you will be able to provide evidence of your disability to the insurer.  Also, the quality of the evidence matters very much.  This blog will give you some pointers on what to gather before you hire an ERISA attorney to assist you with your appeal – and you should definitely hire an ERISA attorney to help you because the appeal is your only opportunity to provide the insurer with the necessary evidence to properly support your claim.

  • Request your claim file – if your claim has been denied, you should request a complete copy of your claim file from your insurer. This will help the attorneys to ascertain whether you have a case they can assist you with and what evidence you will need to support your claim;

Posted by:  Andrew M. Kantor

Happy 2019! In honor of the New Year, I wanted to take some time to discuss some of the newer developments in the world of Disability Insurance.

Advancements in the Fight to Acknowledge ME/CFS

In January of 2018, Judge Lawrence O’Neil issued a scathing ruling against Sun Life Financial, finding that it acted arbitrarily and capriciously when denying Ms. Vicki Young’s claim for ongoing disability benefits, and awarding said benefits to the Plaintiff, Ms.Young.

Ms. Young is a 62-year-old former mortgage broker who suffers from a severe form of fibromyalgia, and several other co-morbid conditions. After paying her LTD benefit for several years, Sun Life decided to terminate her benefit, arguing that the independent physician to whom Sun Life sent Ms. Young concluded that Ms. Young was able to return to a sedentary job, and that Ms. Young’s own physician agreed with that conclusion.

Judge O’Neil agreed with Kantor & Kantor’s argument – on Plaintiff’s Ms. Young’s behalf – that not only did Ms. Young’s treating physician support her disability claim (and was merely confused by an intentionally misleading form), Sun Life’s own independent physician actually gave restrictions and limitations which precluded Ms. Young from returning to applicable work under the terms of the policy.

Insurance is our safety net.

It’s our protection against the unthinkable. Our first line of defense when something goes wrong. Our safeguard for our health and our finances. Our security for our family and our homes. Our precaution against all the “what ifs.” Our surety in protection of our resources and access to healthcare and treatment.

On paper, health insurance sounds pretty anticipative and hopeful. It sounds like if an illness or tragedy were to strike, things would be okay in the end – because someone would be there to catch you. But the harsh reality seems to be a security net with many holes and many flaws. In the hands of insurance companies, so many people seem to be falling through the holes of the net, slipping through the worn out spaces, and some even missing the net completely as they fall.

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