Disability insurance companies avoiding payments owed

There are people across the country reading today’s story who have a large presence on Facebook and other social media putting them at risk of losing thousands of dollars yearly, as you will see in a moment.

But first, let me tell you about “Andy,” whose story is an example of “The big print giveth and the fine print taketh away.”

“Many years ago I obtained group disability insurance for the employees of my roofing company. The policy says that insurance will replace lost income if an employee became disabled and was unable to do their customary job.

“Andy had a stroke at home, leaving him partially paralyzed, with severe balance and speech problems. He tires quickly, has no stamina, even now, two years since his stroke. He has been receiving disability insurance benefits all this time.

“While he can’t climb up on roofs, occasionally he hangs-out in our office, chatting with staff and customers. He is not paid for this – he just loves being around people. It is therapy to combat depression. His wife drives him here, but he can only spend a couple of hours before visibly becoming fatigued. He simply can’t work.

“About a week ago the insurance company sent a letter with a link to a video of Andy at our office, talking with customers. The letter stated, “As it is clear he is able to work and is dealing with your customers, disability benefits are ending immediately.”

“Mr. Beaver, this is so wrong! Andy can’t work! What can we do? Thanks for your guidance, Jeff.”

Denying Claims/Cutting People off Happening More Often
 
I ran Andy’s situation by two attorneys whose practices concentrate on disability insurance claims: Jason Newfield from Garden City, New York, and Alexander A. Palamara of Hollywood, Florida.

“I hear these stories every day,” Newfield says. “There is a definite push among disability insurance companies to deny legitimate benefits to people who qualify and, in many instances, have been receiving payments for years. This effort to cut policyholders off has only gotten worse this past year.”

So, why the past year?

“Disability insurance companies have taken a hit financially as millions of policyholders were unable to pay premiums, and due to Covid, valid claims for both disability and life insurance have increased dramatically. Companies are resorting to age-old tactics by disputing clear evidence of disability, or, as with Andy, trying to show the person is capable of working,” he points out.

Time – 24 Months and Counting – Don’t Let Video Fool You!

Palamara sees Andy’s situation as typical. “Often, after receiving benefits for 24 months, suddenly people are denied further payments, because, in most policies, the definition of disability will change around the 24 months mark.

“For the first 24 months, a claimant has to prove being disabled from their own occupation. After 24 months, it is being disabled from any gainful occupation for which they are qualified based on their training, education and experience. Also, can they perform a job that pays them 60% of their prior monthly earnings?

“Insurance companies rely on video surveillance which can seem damning, but never assume that all hope is lost! Just because a person can do certain things for a few hours does not mean they are not disabled. It does not mean they can work 40 hours a week, 50 weeks a year. Videos do not show the person being down for the next two or three days, especially if they overextended themselves the day they were caught on surveillance,” he underscores.

Social media can Sink Your Ship

“If you are applying for long-term disability or receiving it now, be aware of the damage you can do to your case by painting a glossy, ‘too-good-to-be-true’ version of your life on Instagram feeds and Facebook time-lines,” Newfield says.

“Many of us want to present a rosy picture of our lives to the world, but that can backfire when you have a long-term group disability claim pending.

“Increasingly, investigators will comb social media looking for evidence that they can take out-of-context to suggest that your claim is not legitimate.

“Try to stay off of social media, if possible, if you intend to file a long-term group disability claim. Any activity on Facebook, Linked-In, or Instagram where you travel, party, fly or engage in any action the carrier deems inconsistent with your restrictions and limitations will quickly result in a denial.”

If You Receive a Denial Letter

Both attorneys caution anyone facing a denial of disability insurance benefits, “To understand there are appeal rights, but do not handle this by yourself. Speak with an attorney immediately.”

Their websites are well worth your time: frankelnewfield.com and diattorney.com.