When you are unable to work due to a disability and qualify for long-term disability benefits, you should be aware that your insurance company is monitoring your claim for a variety of reasons.
You often hear of claims being denied, especially disability claims and for accident victims, this is a frustrating process.
This blog post aims to assist you in understanding why disability claims get denied.
What you need to know:
1. Be Wary of Surveillance:
The insurance company will likely hire an investigative company to take photographs and video footage of you during the course of your active claim. This can often occur without your knowledge but the insurance company, believe it or not is entitled to do this. So long as you are honest and truthful and do not engage in activity that your treatment providers recommend against, the surveillance will be of little or no value. If you attempt to try new activities you should always report them to your doctor, as well as any changes in pain levels. If your insurance company believes surveillance proves you are capable of working, they will possibly deny or terminate your claim.
2. Be Careful of What Content You Create in Social Media Accounts
In a way, social media accounts have become another form of surveillance. Have you ever googled yourself? Are your social media accounts public and easily accessible? Does your lawyer know you have social media accounts? Has your insurer realized you do?
If you believe your insurer may be looking at your Facebook account for example, do not alter it in any way. What you can do, is be sure to preserve the content and be wary of new content you create. Do not post pictures that would undermine your disability claim or that would cause your insurer to question your credibility. Photographs or videos demonstrating intense physical activity or socializing when a disability claim is made for depression or severe pain will not help your credibility. Even if your social media postings are not deemed relevant, the insurer can make assumptions about the quality of your character.
Remember, if you can find any content you have created on the internet in Google, so can your insurance company.
If you are already involved in litigation, do not delete your social media accounts as the insurance company may find this suspicious. Investigate what privacy settings are available for social media accounts before you decide to sign up for them.
3. Attend Rehabilitation Treatments
By attending rehabilitation treatments regularly, you are actually strengthening your case. You are showing that you are willing to seek treatment and help yourself. This assists the strength of your claim. By seeing your family doctor, going to physiotherapy, for massage, to specialists when necessary and taking all prescription medications you demonstrate to the insurance company that you do suffer from a valid disability and are unable to work.
Long-Term Disability policies (and short-term disability policies) generally require claimants to be under the regular care of a qualified physician in order to qualify for LTD benefits. Even if your LTD claim is denied, you should continue treatments and doctor visits at the appropriate intervals for the purpose of establishing credibility.
4. Know your Limitations
The person who manages your claim at the insurance company is usually titled “disability claims manager”. There may come a point when your disability claims manager thinks the medical condition you are suffering from and its accompanying symptoms are not severe enough to prevent you from being able to return to your pre- disability employment.
Why does this happen? When the wrong information is given to the insurance company about job duties, and medical status. For example, consider the fact that the insurance companies internal medical staff to conduct “paper reviews”. How can you evaluate a claimant without meeting him or her in person?
This is why it is important to know your limitations and restrictions and take in all the advice of your doctors and rehabilitation facilities. An example of a restriction is the inability to push or pull more than 15 pounds if you have a serious back injury or related medical condition. AÂ limitation is an action or task that a person can only do for a certain period of time as a result of their symptoms. An example would be only being able to sit or stand for no more than 10 minutes due to fatigue caused by chronic pain/fibromyalgia.
5. Understand Objective Evidence
Reporting complaints of pain and discomfort to your primary physician is necessary. How do you prove chronic pain and other such conditions? Sometimes claimants will find that insurers discredit their claims for chronic pain for being subjective.
Documentation is crucial. Doctors cannot guess how you are feeling. Doctor’s reports consist of their observations, both observations they have made and that you have provided them with. Your observations will consist of your list of symptoms and complaints related to your injuries.
Helpful tips are to keep a pain journal to track your symptoms and to make a list of your symptoms from head to toe so you make sure you are always reporting all of your symptoms.
When your doctor is asked to write a report by your lawyer or to provide an update to the insurance company, he or she always reviews your medical chart to know what your current status is.
Aaron Waxman & Associates is a Toronto Personal Injury Firm specializing in disability claims. Contact us for a free consultation and let us help you with your claim and to protect your rights today.
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