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Top 5 Reasons for Disability Insurance Denial - YouTube
Channel: Dell Disability Law
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hi I'm Gregory Dell and I'm joined today
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by attorney Rachel altars hello Greg and
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today we want to discuss with you the
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top 5 reasons that long-term disability
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insurance claims are denied so Rachel in
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preparation for this video I know you
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put together a list of the 5 most common
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reasons that you see people are denied I
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know you've handled hundreds if not
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thousands of ERISA disability Appeals
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let's start with what's the number one
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reason that you see disability claims
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are denied Greg the number one reason I
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see disability claims denied are when
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the policyholder happens to be filed
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around by private investigator with
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surveillance cameras it happens all the
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time especially when you mean like
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personal video cameras video cameras
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right the the pollen the insurance
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company will hire private investigators
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to follow the claimants for two days
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three days four days depending whatever
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they think is appropriate to see if the
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claimants doing anything that they
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claimed they couldn't do on their
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application or told their doctors they
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couldn't do and this is without the
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knowledge of the claimant correct
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oh yeah the claimant has no idea what
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are these disability insurance companies
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do with this video surveillance they
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what the video surveillance what they
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normally do is obviously they review
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with they get a report from this the
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private investigator and if they find
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out that the claimants doing something
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that they claim they can't do then
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they'll deny the claim and do they
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reference that video to claim a
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statements medical records how what do
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they apply it to the video well they
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usually will apply the video they'll say
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for example that the person is you know
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using a cane in one instance and and
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claiming that he can use a cane or has
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to use a cane and then they catch them
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going to the mall walking around and
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without the kid without the cane and so
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they'll say okay you know they were
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lying they're lying about their
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inabilities to work and we believe they
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can go back to work what's the second
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most common reason that you see that
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claims are denied the second most common
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reason is when the in the policy usually
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the policies written in a way that
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allows the insurance company to send the
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policy holder for an examination a
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compulsory medical examination which is
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either an IME which is an independent
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medical exam or an FCE a functional
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capacity evaluation and these doctors or
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therapists
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hired by the insurance companies and
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what they do is they put them through a
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three-hour for our examination trying to
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test them to determine whether they can
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work and a lot of these times you know
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after the reports written by these
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doctors now not every claim is denied
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after an IME right or an FCE
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but a good a good majority of them are
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because these doctors are paid by the
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insurance companies to write reports in
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their favor now you set a three or four
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hour exam that's usually an FCE exam
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which is a functional capacity exam and
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Ayami can be a little shorter okay
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because i often get calls where they say
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oh the doctor looked at me for fifteen
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minutes he didn't even he didn't even
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touch me he just had me come in and he
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rendered his report after is that
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something also that could happen that
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does happen a lot what's the third
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reason that you find claims are denied
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the third reason claims are denied is
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when there's a change in the policy
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definition so for example most policies
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not all but most of them have a 24 month
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own occupation period which means that
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you can't do your own job for 24 months
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and you're talking about the definition
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of disability the definition of
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disability right because if you you have
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to have to fall into that definition in
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order to become be disabled so if you
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can't do your own occupation for 24
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months there's a certain standard and
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then after the 24 months expires its it
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becomes another standard of disability
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and it's a much more difficult
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definition to fit into because what
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they're trying you're trying to show the
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insurance companies you can't do even
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sedentary work sitting in a desk all day
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long you know that's right and
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everybody's everybody's policy has a
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different definition of it could be Oh
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knock for 24 months and then some of the
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any occupation definition could have an
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income component like unable to earn
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sixty percent or 80 percent of what you
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used used to earn or it can just be
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unable to do any gainful occupation like
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a Social Security disability standards
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sure when do you see that a disability
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company when they're gonna when a person
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has a change of definition when do they
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start looking into whether or not the
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person is going to be eligible at that
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24 month mark usually you'd see it about
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six to nine months before the definition
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change and at that time they do things
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like they will send out the private
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investigator to do video surveillance
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and see if they're doing anything that
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they shouldn't be do
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your claim that they couldn't do this is
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one they'll send them to imes for
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example so they can get a report that
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shows that they can work and this is
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what happens approximately six to nine
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months before the definition change and
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then that's when you'll see a denial
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okay let's talk about the fourth reason
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that disability claims are commonly died
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the fourth reason I find that they're
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denied is when there's improper
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documentation by the claimants
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physicians a lot of times and we know we
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all go to doctors and some of them are
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rushed and some of them don't want take
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the time to write notes very carefully
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and detailed the problem with that is
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when the notes are written and they're
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you know not written specifically to
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show that you're disabled and still
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having many restrictions of limitations
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then those notes get sent to the
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insurance company and when they see that
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you know oh look you know mr. Smith had
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a good day today he was feeling good
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that gives them another reason to deny
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him right because I see unfortunately
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all the time they get one record
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so-and-so had a good day today or
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so-and-so neck was fine when they have a
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neck problem and three four days later
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there's a denial letter absolutely just
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right even though there's been you know
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thirty records before and you know two
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records after that say that they're in
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pain if you have that one note that says
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they're doing okay they can tonight and
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then what kind of claim and do to avoid
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that kind of situation anyway it's
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communication with your physician so if
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you have a good relationship with your
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doctor you need to tell them listen this
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is very important that you document my
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restrictions and limitations very
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clearly because without that you know
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I'm gonna lose my insurance my
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disability income and this is something
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I need to live on so if your doctor is
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an understanding and you know willing to
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discuss and work with you on that it
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usually I mean would you recommend that
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a claimant actually looks at the medical
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records that are transcribed absolutely
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and how often should they do that I
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would hold on a monthly basis if they
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could so basically every visit that they
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go they should get a copy of the records
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if there's something they're not happy
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with then they need to communicate with
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their doctor and say listen can we be
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careful when you document because this
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really affects my income right okay
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let's talk about the fifth reason that
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claims are commonly denied the fifth
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reason that claims are denied Greg are
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is usually in
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happens all too often I see this when I
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get you know calls from potentials and
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they make mistakes on their claim forms
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or their applications and the problem
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with that is that when you fill out a
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claim form and you're not filling it out
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properly this is something that stays in
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the record and the insurance company
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will make denials on this issue often
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and doctors do the same thing will
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they'll make a mistake when they fill
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out a claim form that sent by the
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insurance company
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so they'll accidentally check that the
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person can work right when they can't
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and sometimes that's because maybe the
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office manager or since one of the staff
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is filling it out instead of the doctor
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and you know they're rushed and they
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don't want to deal with the paperwork
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and it gets sent to the insurance
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company and then there's a denial right
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I've seen things as simple as the box
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says how many hours in a day can they
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sit and the doctor checks six hours or
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eight hours when the person can't even
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sit for two hours so I mean so you're
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talking about mistakes and these the
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initial application claimant forms that
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are going on a monthly basis even
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someone has been on claim for five years
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negative claimant statements every month
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or every six months and then the doctors
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get these attending physician statements
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and they can make mistakes on those as
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well again I mean what kind of claim and
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do to try to avoid those kinds of
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mistakes well you know claimant could
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could hire somebody to be their advocate
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so the mistakes don't get made so the
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claim forms come through for example if
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we were representing them they come
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through come to our desk first we review
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them make sure there's no mistakes
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before they get sent to the insurance
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company and the same you know the same
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thing when the doctor fills them out
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they can get sent to an attorney first
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to make sure that everything was filled
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out properly and if it wasn't we can
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send it back and get it done right
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because once it's in that claim file
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it's there and it's very hard to reverse
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a decision you know once they make up
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their mind to deny then they're in the
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process of having to appeal the case
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right and that's part of that monthly
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claim handling service that we offer
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where we always review all the medical
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records review the claimant statements
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review the attending physician
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statements review all the communications
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that come back and forth from the
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disability carrier because look person
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gets on claim they're sick you know that
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they weren't they didn't they don't have
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experience with handling a disability
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insurance policy and knowing every
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single thing they have to do
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in order to keep getting paid but you
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know if there's one opportunity than I
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accompany is going to jump through that
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door and deny it absolutely and a lot of
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times you know the claimants are
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depressed and they don't have the energy
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to deal with it either and so it's
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something that they you know don't have
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the capability of in right well Rachel I
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want to thank you for putting together
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that list of the five most common
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reasons that people are denied long term
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disability benefits I want to tell our
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viewers that if there's any type of
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claim that you have whether it's an
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application a monthly claim handling
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issue or if you've been denied feel free
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to call us at any time for a free
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consultation we'll be happy to review
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your policy discuss your claim with you
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and if we're able to help you we'll let
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you know
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