What happens during the investigation of my disability claim?

The investigation of a long term disability (LTD) claim is not limited to simply analyzing medical records.  Claims Administrators will frequently make use of a variety of techniques during the investigation of a claim.  Most Claims Administrators will begin an investigation by requesting your medical records from the treating physician identified on your claim form.  However, there are many other methods utilized that you should be mindful of.

  • Background Checks: this type of investigation could include an interview with your neighbor, requesting your employment records for review, or requesting any records relevant to a filed Social Security or Worker’s Compensation claim. You are obligated under the Plan document to cooperate with investigation of your claim.  However, the Claims Administrator is not permitted to unduly harass or invade your privacy.
  • Medical Examinations:  unfortunately, the independent medical examination (IME) is rarely “independent”, as the doctor retained is being paid by the Claims Administer. Most policies express the right to conduct such an examination, even so, you should be sure to check the language in your Plan before agreeing to submit to examination.
  • Surveillance: be aware that surveillance techniques can be utilized at any time by a Claims Administrator during the initial claims administration, and even after benefits have been approved. We frequently see surveillance applied by the Claims Administer during a clients’ IME (independent medical examination) or FCE (functional capacity examination).  In addition to surveillance during medical exams, we have also found this to take place in everyday situations- walking to your car, taking the trashcans out, running errands, participating in an activity, or Facebook postings/pictures that describe you engaging in an activity. You should understand that the Claims Administrator can use this information against you to argue that you are not disabled.
  • Medical, employment, and financial records: the Claims Administrator will often request that you sign an Authorization for Release of Confidential Information. We strongly encourage you to carefully review any release before signing.  Question any release that allows for the disclosure of your school or employment records to find out how such information is relevant to your claim.
  • Telephonic or in-person interview:  the Claims Administrator may request a telephonic or in-person interview.  You have a right to record the interview by audio or video tape.  If the Claims Administer does not allow you to record the interview, confirm this refusal in writing! Offer to submit to a written interview, meaning you will respond in writing to any written questions submitted by the Claims Administrator.

It is important that you are prepared for the many techniques your insurer can use to deny your claim.  Many people do not understand the struggle of living with Rheumatoid Arthritis, and will take advantage of any evidence that they can use to try and contradict your disability.     

Dealing with your insurance company and a chronic illness can be exasperating and tiresome.  We can help.  If you have questions about your LTD claim, call (800) 446-7529 or go to www.kantorlaw.net.  We offer no cost consultations and work on a contingency basis, which means we do not collect a fee unless we get your claim paid.

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