Misunderstanding The Definitions Of "Disability" And "Occupation"
There's no such thing as a standard policy. Most professionals buy "own-occupation" policies that compensate following a disability that prevents the insured from performing the particular duties of his/her occupation. Thus, the insured may be entitled to benefits even if he/she could in fact perform different work. The central issue is often the definition of "total disability," which could variously mean that the insured can't perform "every" duty, or the "substantial and material duties" of his/her occupation. Similarly, the term "occupation" may be specifically defined or may refer to the insured's occupation immediately prior to the time benefits are sought. In the latter situation, if the insured reduces hours preceding claim filing, the carrier may consider his/her occupation to be part-time. Similarly, the term "occupation" may be comprised not only of the duties of an insured's specialty, but also travel time, teaching or other areas in which he/she spends time.
When submitting a claim and speaking with a carrier, it is important to take notes to assist in remembering what was said in the event that a claim is denied. Keep notes of all telephone conversations, including the date and time of the call, what was said, and identifying the person with whom you were speaking. Every conversation with the carrier should be confirmed in a letter sent by certified mail so that there are no misunderstandings. The "paper trail" may later be used as evidence to establish unreasonable treatment during the claim administration process. Starting with your first phone call to the carrier, you should document in detail your conversations and meetings, and confirm everything in writing sent by certified mail.
Ignoring The Possibility of Surveillance
Once you file for disability insurance benefits, you will likely be videotaped or photographed by your carrier at some point in time. If you are engaging in any activities that you claimed you could not perform, and that is caught on tape, your benefits will likely be denied and your contract could be terminated. It is crucial not to compromise your policy benefits by submitting a fictitious claim.
Blindly Accepting That Subjectively Diagnosed Conditions Are Not Covered
Disability insurance carriers often deny benefits by insisting that the insured's subjective symptoms do not provide objective, verifiable evidence of disability. In many cases, there is no provision or contractual requirement mandating that the insured submit objective evidence of disability. Therefore, from the insured's perspective, these insurance companies are merely trying to save money by generously interpreting policy language in favor of a claim termination. Notwithstanding the subjective nature of a particular condition, the insured may be able to secure benefits with ample evidence bearing on the extent and severity of his or her limitations, which is far more important that providing a definitive diagnosis. The severity and extent of your limitations are more important than an objectively verifiable diagnosis and must be fully communicated to your insurer.
Tossing Out Your Application, Policy And Claims Documents
From the time of application forward, you should keep copies of everything (including your notes from meeting with the insurer's sales representative or agent, the policy application and the policy itself). If the sales representative provided you with a letter or a verbal representation that you jotted down, your notes can go a long way if the insurer says that the policy says something different. Similarly, information that you provided on your application may have a bearing on your reasonably expectations at the time of purchase. Keep all of your disability insurance papers and notes in an organized file.
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