Claimants and some attorneys handling ERISA and private disability income insurance claims may be unaware of some of the idiosyncrasies of ERISA and disability income insurance law. They should not be lulled into a false sense of security
Because ERISA is a Federal statute with its own strict time constraints, no jury trials, and court deference to an insurance company’s judgment, there is additional special knowledge every claimant and lawyer should know in pursuing ERISA claims.
But, getting back to the idiosyncrasies which affect both ERISA and private disability claims:
* If the claimant is scheduled for an IME (Independent Medical Exam), it’s a photo op for the insurance company and they are almost certain to have a surveillance camera on the claimant on the day of the IME to try to cast doubt on the insured’s disability claim. (more on this)
* A claimant’s Facebook, etc., posts are meat for the insurance company’s grinder. These posts are public and insurance companies go hunting through them to try to catch one picture or statement which might suggest (accurately or not) that a claimant is not as disabled as he or she claims. (more on this)
* Not all psych material is discoverable by the insurance company. HIPPA clearly exempts psychiatric notes from discovery without the client’s permission, but this doesn’t keep the insurance companies from pressing claimants, their lawyers and mental health providers for them. Insurers just love to know a mentally impaired claimant’s darkest secrets, because they know this may disturb a psychiatric claimant’s mental equilibrium just at the time when they are most vulnerable. More importantly, it may provide fodder for the defense argument that the insured is not really impaired at all, but hates his boss or the guy he works next to. Even some practitioners in the mental health field are not aware of the danger they may put themselves in by disclosing such information without the patient’s permission. (more on this)
* Claim denials are a very common reaction of insurance companies to any LTD (Long Term Disability) claim. These claims can turn out to be quite expensive. Insurers make every effort to try to discourage them. (more on this)
* If a claimant has any psychological problems in addition to physical problems, most carriers will do whatever they can to make it seem that the psychiatric problem is the cause of the disability, rather than the other way around. This is because most ERISA and many private disability income insurance policies severely limit the payment of benefits for psychiatric disabilities to no more than 2 years. Non-psychiatric disability benefits may be payable to age 65, or even longer, depending on the policy terms. (more on this)
These are some of the more basic “ins” and “outs” we’ve picked up in practicing ERISA and private disability income law for more than 30 years. They should not be kept a secret, because failure to be aware of some of these things can really hurt an insurance claimant.
The last thing any claimant or their lawyer should want is to see the insurance company knock out a claim for want of insurance claims knowledge or experience.