Insurance policies serve as a safety net, offering protection and peace of mind against unforeseen events. However, when the time comes to claim benefits, claimants may encounter challenges, some stemming from the tactics insurance companies employ to prematurely terminate claims and minimize payouts. This guide sheds light on these strategies and offers advice on countering them to secure the benefits rightfully owed.
It’s essential to recognize that insurance companies, like other businesses, operate to generate profits. While many claims are settled without issue, some claimants may encounter resistance, delays, or denials. Recognizing and combatting these tactics ensures a fair and just resolution.
- Common Insurance Company Tactics
- a) Delaying the Claims Process: By prolonging investigations or requesting repeated documentation, insurance companies might hope claimants will become discouraged and abandon the process.
- b) Denying Liability: Insurers might argue that there is insufficient medical information to support disability, that there is no objective evidence to support disability, that the claimant is able to work in a different occupation or the claimant has violated the policy’s terms by refusing to attend a medical assessment or participate in rehabilitation or return to work
- c) Surveillance: It is not uncommon for insurers, especially in disability claims, to employ surveillance to determine if claimants are as impaired as they state and try to identify inconsistencies
- d) Offering Lowball Settlements: Initial offers might be significantly lower than the claim’s actual value, hoping claimants will accept due to financial concerns
- e) Requesting Independent Medical Exams (IMEs): Sometimes, these “independent” exams are conducted by professionals with a history of siding with insurance companies.
- Empowering Policyholders: How to Counter These Tactics
- a) Document Everything: Maintain a detailed record of all interactions with the insurer, including phone calls, emails, and mail correspondence.
- b) Seek Medical Treatment and Documentation:. To pursue a disability claim, you require ongoing evidence of medically verified functional limitations. The insurance company has an ongoing obligation to adjudicate your claim and will want to see ongoing medical records supportive of your disability. c) Be Wary of Initial Settlement Offers: It is beneficial to consult a lawyer before accepting any settlements to ensure you are receiving a fair deal.
- d) Understand Your Policy: Request a copy of your insurance policy from the insurance company. Familiarize yourself with all terms and conditions. This knowledge can be invaluable in refuting unjust denials.
- e) Engage Legal Representation: Having a lawyer on your side who specializes in insurance disability claims can tilt the balance in your favour.
- Going Beyond the Basics
- a) Avoid Social Media: Sharing details about your activities, your condition or claim on social media can be used against you. It’s best to stay low-key online during the claims process.
- b) Consistent Treatment: Following medical advice and keeping regular appointments demonstrates commitment to your recovery and strengthens your claim. It may also be a requirement under the insurance policy and by law.
- c) Don’t Succumb to Pressure: Stand firm, especially when faced with tactics aimed at making you feel guilty or uncertain about your claim. It is not uncommon to feel doubted, pressurized or intimidated by the insurance company. If you do, reach out to a disability lawyer to understand your rights and strengthen your position.
- Preparing for Appeals
If a claim is denied, it’s not the end:
- a) Review the Denial Letter: This document will outline the reasons for the denial, providing a starting point for the appeal.
- b) Gather Additional Evidence: Bolster your claim with further medical documentation or medical opinions.
- c) Legal Support: Especially in appeals, having an experienced disability lawyer with insight into how insurers operate assist you with the process can make a significant difference.
- Closing Thoughts
While insurance claims can be processed by the insurer without complications , being prepared for potential challenges ensures that you are not caught off guard. Recognizing tactics and having strategies to counteract them empowers claimants, ensuring they receive the benefits they rightfully deserve.