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Excuses Insurers Will Use to Terminate Your Long Term Disability Benefits

Strategy Strategy - Maintain Benefits

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At Riemer & Associates, our disability attorneys in New York assist clients with the preparation of the insurer’s request for updated information on a daily basis from all of the major disability insurance companies.  The process may appear to be a simple matter of obtaining and submitting the requested information, but this process does not come without challenges.  Given our experience with the various insurers, we have developed proven strategies to overcome these obstacles.  Beware of the following Red flags.

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Alleged "Improvement" in Your Condition

Your treating physician and/or the medical records indicate that your condition has improved.  Insurers are often quick to interpret an improvement, as evidence that you are no longer disabled.  If there has been an improvement in your condition, we will ask your physician to put the improvement in perspective and explain why you remain disabled despite the improvement, including associated restrictions/limitations.


Restrictions/Limitations Assessed by Your Physician 

Your physician will be asked to assess your restrictions/limitations by completing a Physician’s Statement Form.  The forms are often constructed to trap the unwary.  For example, the forms will ask the physician to indicate how long you can sit/stand/walk in broad categories:  “occasionally,” which is 1-33% of the time; “frequently,” which is 34-66% of the time; and “continuously,” which is 67-100% of the time.  Even if the physician intends to opine you only retain the capacity to sit 1%, stand 1%, and stand 1%, he/she may check the box for “occasionally” (Indeed, that may be the lowest choice on the insurer’s form).  The disability insurance companies, however, may interpret the form as indicating you can sit 33%, stand 33%, and walk 33%.  The forms also have a heavy focus on the physicality of your occupation without regard to the cognitive and stress demands of your job.  In order to avoid this trap, we will work with your physician to make sure that he/she is not misinterpreted.  Depending on the circumstances, we may have the doctor create a category on the form for “rarely (1 to 10%)” of the time or help the doctor prepare a narrative that explains your condition in more detail.


Alleged “Inconsistencies” 

The insurer will review the updated information for alleged “inconsistencies.”  For example, the insurer will compare your physician’s statement, your statement, and medical records, to assess whether the information provided is consistent and corroborative.  For example, if you state you are bedridden and never leave the house, but there is a notation in your treatment notes that you recently went on a family vacation to the Caribbean, this will be interpreted as a red flag.  The insurer may send your claim to its special investigations unit, which may conduct an extensive investigation utilizing commercial databases, social media sites, and/or retaining an investigation firm to conduct video surveillance.  In order to avoid unreasonable, strict scrutiny of your claim, our disability attorneys in New York will closely scrutinize the update packet to help avoid “inconsistencies.”


The Insurer’s Interview/Examination

The report generated after your interview and/or examination requested by the disability insurance companies also will be reviewed for red flags.  The reports, unfortunately, may contain errors and/or misrepresentations.  In order to avoid this situation, we will arrange your interview to be conducted at our office or by telephone so that Mr. Riemer can personally monitor the discussion.  In the event the insurer requests an examination, our disability attorneys in New York will arrange for a nurse to accompany you to observe and document the examination.  We also will request a copy of the report and CV of the interviewer or physician from the insurer.  This will give us the opportunity to verify the accuracy of the report and submit comments, if necessary.

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