Sneaky Surveillance Tactics Insurers May Use to Deny Long-Term Disability Benefits

Disability Insurance Lawyer Los Angeles

Long-term disability insurance firms spend a lot of money yearly to spy on their claimants. On top of performing surveillance, insurers want to “catch” individuals doing activities that are not consistent with their disability claim. If the insurance company is successful, it will use the evidence to deny the claimant’s long-term disability benefits, saving money.

How far will your insurer go to spy on you? Insurance companies are willing to use these tactics:

Background Checks

An insurance firm hires a third-party investigator to perform a comprehensive background check on you. The report from the in-depth screening can include the following information:

  • Your physical address
  • The people living with you (e.g. parents, children, significant other, etc.)
  • The kind of vehicle you drive
  • Criminal history, including driving offenses
  • Active permits and licenses
  • Business registered in your name (or your partner’s name)
  • Properties registered under your name

The investigator uses the information from the report as a starting point for further surveillance.

Photo and Video Surveillance

Investigators usually park outside your house for a couple of days and use a small camera. They sit in their vehicle for hours and wait to pick up activity on their recording device. If you leave your house, the investigator may secretly follow you and continue to record your movements once you have reached your destination.

When it comes to photographic or video surveillance, investigators want to find out whether you leave your house, what you do when you go out, and how frequently you leave your home. They also take note of the following minor details:

  • How you dress (e.g. in sneakers or high heels)
  • Any items you carry, including a bottle of water and a handbag
  • Any assistive devices you’re using, such as a wrist brace or a cane

When investigators capture small but useful snippets of activity, the insurance firm uses them as evidence to deny your claim.

Social Media Checks

Accessing social media accounts is generally a simple and affordable way for insurers to gather personal details about their claimants. Many profiles contain vast amounts of information that the insurance company can use to draw conclusions.

Investigators usually search for your name in any of these popular social media sites:

  • Facebook
  • Twitter
  • Instagram
  • LinkedIn

When investigators perform searches, they look at your activity and note down the following details:

  • Comments on interactions and posts with other users
  • Photos and what you’re doing in those photographs (e.g. pictures of recent vacations)
  • Status updates
  • Location
  • Relationship status
  • Hobbies
  • Employment status
  • Profile picture

General Web Searches

Insurers also perform general internet searches to find any information that’s inconsistent with your long-term disability claim. They may search the web for the following:

  • Articles about you
  • Photos of you
  • Comments you post on blogs or other sites
  • Personal and business web pages

Individuals who received a notice of denial from their insurer can seek the help of Haffner Law. Our experienced disability insurance lawyers in Los Angeles guide clients through the appeals process and help them get the benefits they need.

Contact us today for a free, no-obligation consultation.

Long-Term Disability Insurance Appeal: Your Next Step After a Denial

Disability Insurance Lawyer in Los Angeles

Long-term disability (LTD) insurance is a beacon of hope for injured people struggling in the aftermath of an accident. If your disability continues longer than six months, your LTD insurance will cover your needs as long as your disability lasts. For this reason, it’s best to immediately file for a claim application to receive benefits as soon as possible.

But what do you do if your claim gets denied?

Why LTD Applications Get Denied

The Employee Retirement Income Security Act (ERISA) is a federal law that governs all established health and pension plans in private organizations, which include employer-provided long-term disability policies. As per ERISA, claim administrators who work for the insurance company are in charge of evaluating the claims. Due to the inherent conflict of interest, claim adjusters deny deserving claims even if there is clear evidence of disability.

There are different reasons behind an adjuster’s denial. Some of the most common include the following:

  • Insufficient medical evidence
  • Video surveillance inconsistent with allegations of disability
  • Failure to meet the policy’s definition of disability
  • Missed deadlines

If an adjuster denies your claim, don’t lose hope. Some insurance companies initially deny claims, regardless of their merit. With persistence, patience, and the help of experienced disability insurance lawyers in Los Angeles, you can still appeal for your insurance claim. However, there can be strict and short time limitations for appealing a denial of disability benefits, so you must determine the deadline and act quickly to submit your appeal.

Appealing Your Denial: The First Steps

Get a copy of the policy. Obtain a copy of your long-term disability policy documents, which should also include the summary plan description. You can get it directly from the insurer or from your company’s human resources department (for businesses that provide group insurance). If both parties fail to provide these documents, you can request them from the insurance company’s plan administrator.

Study your denial letter. With your disability attorney, review the denial letter sent by the insurance company. Take note of the reasons behind the claim’s rejection and gather other information to support your claim’s approval. Don’t forget to mark deadlines on your calendar, too.

Strengthen Your Case with Favorable Evidence

Track down missing records. In some cases, plan administrators and insurers fail to obtain all the medical records relevant to your claim. Strengthen your appeal by finding out which records were used to decide your case. If anything is missing, let your claims administrator know and determine the date when they received and requested all the records.

Find out if medical tests would help. Most insurance companies cite the lack of medical evidence as a basis for denying your claim. Get in touch with your claim administrator and ask if medical testing, such as blood tests, MRIs, or x-rays, would help your case.

Seek your doctor for a written opinion. Ask your doctors to provide a written opinion that lists down work-related limitations caused by your injury. A disability insurance lawyer can help you craft specific questions to ask your physicians.

When you’re injured or unable to work, disability insurance can help you get back on your feet as soon as possible. Reap the benefits of your insurance by avoiding claim denial or appealing for it with the help of a trusted disability insurance attorney.

Haffner Law’s team of lawyers are eager to assist. Get in touch with us today and let us fight for your rights.

Approved! Supporting Disability Insurance Claims with Evidence

Disability Insurance Claim Lawyer Los Angeles

Living with a disability is rather common. More than a billion people across the globe live with disabilities, many of which were due to a workplace injury, accident, or act of violence. Disability insurance, therefore, is an important type of policy for anyone to have. It serves as a safety net in case a temporary or permanent disability prevents you from working.

However, filing for insurance disability claims remains a challenge for many people. People with legitimate disability claims still get denied, in fact. This may be due to mistakes in their paperwork or the failure to meet the insurer’s definition of a person with a disability.

Hiring experienced disability insurance lawyers in Los Angeles and presenting a solid body of supporting evidence reduces the chances of having your claims denied.

Proper Medical Documentation

Medical documentation is one of the strongest kinds of evidence you can submit to support your disability insurance claim. Records and documents from a licensed health care provider or your primary care physician hold a lot of weight in proving your disability.

Objective Medical Evidence

Objective medical evidence refers to the quantifiable results of procedures or tests. These include diagnostics or imaging tests like X-rays and computed tomography (CT) scans. Blood work results and other findings like blood pressure and pulse rate count as well.

Written Statement from Your Physician

Notes from your doctor, including their diagnosis of your condition and treatment information, strengthen your claims. It’s best to request detailed statements from your physician regarding the effects of your disability and how it interferes with your daily life and full-time work.

Medication Records

Submitting a record of the medications you take for your disability helps validate your claim. Medications, especially those for pain management, are proof of your disability or its effects. A complete record of the medicine you take also reveals possible side effects like impaired concentration, which can support your claims regarding decreased job productivity.

Evidence of Decline in Job Productivity

Aside from medical evidence, you should provide documents proving your inability to perform your assigned work properly. These may include attendance records, records of frequent break or rest periods, and any disciplinary logs. Witness statements from your co-workers or your employer are invaluable, too.

Experts also recommend submitting a detailed job description, preferably from your employer, so that your work requirements are clearly defined.

Timely Submission is Key

Disability insurance claims can be won or lost based on the evidence you provide. Gathering all the medical evidence and supporting statements can be time-consuming, however. It’s especially difficult when you’re still recovering.

This doesn’t mean you are excused from submitting your evidence on time. Take note that having the strongest supporting evidence in the world wouldn’t help if you present it past the deadline. Stay on top of your timeline to avoid this scenario.

Working with Haffner Law will lessen the load on your shoulders. Our experienced disability insurance lawyers will help you gather evidence, understand your insurance policy, and file your claims. We’ll fight for your rights and take your case to court if your claims are unfairly denied.

Contact us today and let us help you get your full benefits.

Pros and Cons of Lump Sum Disability Settlements

Pros and Cons of Lump Sum Disability Settlements

When you are approved for disability insurance benefits, these benefits are typically paid to you in monthly installments for the duration of your time away from work. Once you are medically cleared to return to work, if ever, these benefits will stop and you’ll still make payments on your disability insurance policy in case of future disabilities.

There are some instances, however, when taking your disability insurance benefits as one lump sum is the best option for you. You may need to speak with your insurer to see if this is even an option. Just like with many financial decisions, choosing to take your disability settlement as a lump sum has both its benefits and its drawbacks.

Why You Might Need a Lump Sum Payment

Some people want to buy out the remainder of their disability insurance policy because they aren’t expected to live for much longer and want to make sure their family members receive the benefits they’ve already paid for. Unlike with life insurance, disability insurance doesn’t get transferred to your dependents in the event that you pass away.

Another reason why someone might want to take disability benefits as a lump sum is simply to avoid having to deal with the insurance company anymore. There are always specific criteria that must be met and rules to abide by in order to keep your benefits when you are still paying on a policy, so buyouts are a often great option for those who want to take their money and run.

Reasons Installments Can Make More Sense

Taking your benefits in standard monthly installments could be the better choice for you if your disability is temporary and you hope to keep your policy once you return to work.

If you take your benefits in a lump sum, you’ll no longer be able to collect additional benefits once the policy has closed; if you get sick or become disabled at a later date and have already exhausted your benefits, you may be out of luck and in a financial predicament.

Getting regular installment benefits is also likely to be a better option for you if you want to rely on regular income while you are out of work. Many people who take lump sum payments fail to budget their funds adequately and discover that it’s easy to spend the funds you’ll need to support yourself later.

Call a Los Angeles Disability Lawyer

If you are considering taking your disability benefits as a lump sum but aren’t sure whether it’s the right choice for you, speak with a capable Los Angeles disability lawyer at Haffner Law. We can advise you in accordance with the specific details of your case.

You can schedule a free case evaluation today by filling out the online contact form at the bottom of this page or giving us a call at 1-844-HAFFNER (423-3637).

California Disability Claims Accrue When Disability Ends Under ERISA

A recent decision by a federal district court sitting in Los Angeles is a major victory for insureds in California who submit a late claim after the onset of disability, and are denied benefits on that ground.  This adds to another recent decision upholding a California statute, Orzechowski v. Boeing Co. Non-Union Long-Term Disability Plan, allowing for courts to conduct de novo review of ERISA disability claim denials. The combined effect is creating a uniquely favorable legal landscape in California for challenging denials of disability insurance benefits under ERISA.

On May 1, 2017, in Gray v. United of Omaha Life Ins. Co. (C.D.Cal. 2017) a California federal district court judge sitting in Los Angeles held that the time make a disability claim under ERISA begins to run, not “at the onset of the disability,” but rather when the “period of covered disability” ends.  (Id. at *1.)  In doing so, the court upheld the validity of California Insurance Code section 10350.7, as to when a claim accrues under ERISA.

In Gray, the insured employee worked for a Southern California television station, and was badly injured and disabled in May 2011 car accident.  (Id. at *1.)  Through deception and “stonewalling” by plaintiff’s former employer, plaintiff was unable to file a disability claim until August 2015.  (Id. at *1-2.)  The insurer denied the claim on the ground it was “not timely filed,” based on limitation provision in the insurance plan which was tied to “the day disability commences.”  (Id. at 2-4.)  California Insurance Code section 10350.7, however, provides that a proof of loss is not due, and therefore, the limitation period does not commence, until “after the termination of the period for which the insurer is liable.”  Under California law, insurers can use different language in an insurance plan provided it is “not less favorable in any respect to the insured or the beneficiary.”  (California Insurance Code section 10350.)

Gray held that the phrase the “period for which the insurer is liable” in section 10350.7 “refers to the entire period of disability, and proof of loss is not required until that period ends.”  (Id. at *9 (emphasis added).)  Therefore, Gray held that the insurance policy’s language requiring proof of loss “from the date of the disability’s onset” was less favorable, and thus in violated section 10350.  (Id. at *9.)

Pursuant to Gray, in California, the proof of loss requirement, and related time to submit a claim, is dependent on when the disability ends, not when it starts.  This is a critical ruling which significantly extends the time an insured in California can submit a claim for disability benefits under an ERISA policy.  Combined with other recent decisions, Gray demonstrates that the insured-friendly California laws, and the federal courts decision to uphold and enforce them, is creating a uniquely favorable legal environment in California for challenging insurance company denials of ERISA disability claims.