The play book is thick and rich with possibilities when it comes to insurers’ strategies for delaying, denying or terminating disability claims. Insurance companies make money and achieve productivity goals not by paying out on claims, but, rather, by minimizing or avoiding them altogether.
And they are good at doing precisely that, a point we have noted occasionally for readers of our ERISA Law Center disability blogs. Our proven and nationally established pro-claimant legal team stresses that insurance companies “commonly deny or terminate disability claims and appeals” and do so for a variety of reasons.
Following are just a few arguments used by insurers seeking to deny or terminate disability – especially long-term disability – claim matters. Both applicants and claimants already receiving benefits face insurance company allegations like these:
- Lack of proof establishing a disabling condition per policy terms
- Supportive medical records claimed to be lacking in required detail or not existing
- Insurance company doctor findings that a condition does not preclude the ability to work
- Pre-existing condition disallows coverage
These are just a few examples of how insurance companies routinely deny or terminated benefits to LTD claimants across the country.
Today’s post also notes another challenge that was recently used by an insurer against an individual already receiving LTD benefits caused by a respiratory disease.
That matter relates to an LTD insurer that demanded that the claimant submit to an in-person medical exam in order to continue receiving LTD benefits.
As noted in a national legal article discussing the case, the disabled individual – a nurse – contends that the insurer’s directive is both unsound and unfair. Specifically, it demands “unsafe in-person medical evaluations during the Covid-19 pandemic in order to manufacture bad-faith reasons for denying legitimate claims.”
The case is ongoing and currently being litigated in federal court.