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I had a disability which lasted for about four years.
Went in to litigation and alleged breach of contract and
bad faith. What did I learn?
1. Your insurance commissioner mostly likely will not be able to help you.
Your letters are copied to the carrier and then Insurance Commissioner provides them with
a copy of your letter and then the Carrier really won't answer your concerns or questions.
Respond to the carrier again and provide copy to the Insurance Commissioner and indicate
that carrier's letter was non- responsive. Ask insurance commissioner if there is any
other things that they may help you with.
2. Hire an attorney, expensive in the beginning but worth it in the long run. Make sure your
attorney has handled these cases before. Get all medical records from your providers, a copy of the policy
and all correspondence to and from the carrier, especially keep any "Proof of LOss" documents and your
attending physician statement. Keep a calendar including all your conversations with the carrier and keep a diary of all physical and mental symptoms
as early as possible.
3. After your claim is over, file a complaint with the insurance commissioner and make the
complaint as short as possible - ie. you believe that the insurance company engaged in bad faith claims practice.
There must be a record of all complaints otherwise people will not know who the good carriers are and who the bad carriers are.
4. For ERISA claims make sure your personel department and your immediate supervisor are aware of any and all disabilities and
the effect of the disability on your job performance. For self employed individuals, request from your doctor that a case
manager assist you with documentation to your carrier, an get a "functional analysis" of your job performance.
5. If the carrier requests an IME, hire your own IME immediately afterwards to perform yet another and make sure your IME has
all the medical records, and request a copy of there IME'S report and have your attending physician address that IME's concerns.
If the carrier deny's your claim, go to a medical specialist in the same field as your disability and get him to perform an
IME.
6. Expect that your carrier will make you hire an attorney and sell your policy back for settlement. This may violate your
state law.
7. Have your carrier explain all benefits under your policy and have them explain in detail the reason for there denial in detail.
Most likely you still won't understand it, but it will help your attorney.
8. Go to all your fellow employees and start a petition to change disability carriers as soon as fellow employee is
denied benefits and have your personel dept. contact the agent who sold the policy and strongly urge your company to
change ALL of its insurance needs to another carrier as soon as possible.
9. If you meet with there field representative, IME. Tell them you will be recording the conversation with a tape recorder
if they object, simply tell them you don't want any mis- statements or problems with documentation later.
10. File for Social Security Disability at the same time you file for disability. Carrier most likely will then be able
to reduce there pay out to you but you will get the total amount you are entilted to.
11. Its important to keep a record of all conversations, letters, forms submitted by you or your doctor immediately after
the conversation or submission of documents. They keep a file, but many times the adjustor will fail to document all of
the conversation with you. Be aware that any thing thing you say to any one during this time as it may be discoverable. Thus,
any all activities performed during disability are also subject to discovery.
12. If you are depressed, anxious, having financial problems, social - isolation or limited social activity, problems with
medications or problems working with medications and working (residual disability, partial disability, etc.) Make sure you
tell your physician. Don't hesitate to ask for psychiatric help. Neuro-Psyh test are available for
cognitive disfunction and MMPI (Multiple Personality Inventory's- In my opinion of limited value, we are concerned with
the effects of disability not the classification of a personality type.
13. Make sure your doctor is aware of JOB DUTIES and documents what-why-when-how long-you are unable or able to perform
certain activities. Provide your doctor with your job description and discuss it in detail and have him place it in the
chart. If you have two carriers and one pays give that document to your carrier by certified mail, or go on Family Medical Leave make
sure that your carrier has a copy of FMLA act papers. Have your direct supervisor write out in detail what "Main Duties" or "essential job
duties" etc that you are not able to perform and give that to your doctor and attorney.
Lastly, have your spouse, children, friends, someone help you with all of the above don't try to do this on your own.
The reality is _ THAT YOU ARE NOW THE ADJUSTOR ON YOUR OWN DISABILITY FILE AND YOU HAVE NO TRAINING - but don't feel
bad, most likely they don't have adjustors who are educated either unlike other types of Personal Injury Claims, or
Malpractice Claims. They "process claims" by getting a lot of irrelevant information but make your
file "relevent" to all aspects of your claim.