Long Term Disability Law Blog

Your long term disability claim case manager is not your friend, your advocate, or your confidant. Don’t be fooled. No matter how empathetic, how friendly or how helpful your case manager appears to be, your case manager is your adversary. What you say, can and will be used against you in not only your claim, but in any legal proceeding in the future. Be careful.

Insurance companies make money by collecting premiums, not by paying out benefits. Disability insurers are every bit as bad as the HMOs described in Michael Moore’s recent movie “Sicko.” They do everything they can to reduce the amount of benefits they must pay. One common tactic is to lull claimants into feeling safe and secure by assuring claimants that they are there to help—as if they were part of the team assigned to get the claimant through this difficult time.

What should you do? Be courteous and cooperative, but also be careful. Nothing you say is off the record. Everything you tell the case manager will be evaluated, i.e. could it help support a denial of your claim.

Because what you tell the case manager is so important, think about what you are going to say before each time you speak with case manager. If you are called at a bad time, ask the case manager to call you back when you had an opportunity to better gather your thoughts.

For more information on applications for long term disability benefits, please see the obtaining benefits section of our website.

Disability insurance companies will often ask you to describe a "typical" day. This is a trap for claimants who suffer from a condition with variable symptoms. If you have such a condition, you generally have "bad" days and "better" days. You may have days when you are feeling so bad that you must stay in bed all day, but you may also have days in which you could perform limited activities. You should tell the insurance company both what you can do on your worst days and what you could do on your better or best days. Be careful about the terminology that you use. Do not substitute "good" day for "better" or "best" day. When you describe a day as a "good" day it implies that on those days you are symptom free, which may not be the case.

If you fall into the trap of describing a "typical" day, the insurance company will often assume that that is what you could do on all of your days. Making matters worse, it has been our experience that most claimants who describe their "typical" day unwittingly describe what they could do on one of their "better" days. The insurance company is therefore not provided with any information on your symptoms on your "bad" days. This understates your claim, making it less likely that you will obtain disability benefits.

For more information on applications for long term disability benefits, please see the obtaining benefits section of our website.

The success of a long term disability claim is dependent on proving that your symptoms are disabling. A diagnosis of a particular illness is not enough. You will need to establish that the symptoms that you suffer prevent you from performing the duties of your occupation. How do you do this? By submitting objective evidence, such as MRI's, SPECT scans and other test results; the opinions of your treating physicians, and by providing a statement explaining how your symptoms make you unable to do your job. We recommend that a claimant keep a contemporaneous diary of all symptoms. For instance, if you had a migraine headache on Monday, that should be put in your diary. If you could not get out of bed on Tuesday, that also should be placed in your diary, and so on and so on. By keeping a diary, you can be very specific. Specificity makes your symptoms more credible and allows them to be viewed and evaluated in context.

We also recommend that you bring copies of the new pages in your diary to each doctor visit so that the doctor puts it in your file. This enables the doctor to evaluate all of your symptoms, not just the ones you remember to mention at the visit. It also permits the doctor to keep more accurate treatment notes that reflect all of your current symptoms. This is very important for your claim because the insurance company will often review your doctor's notes as part of their evaluation of your claim.

For more information on applications for long term disability benefits, please see the obtaining benefits section of our website.

The initial call with the insurance company is very important. The insurance company will use it as an opportunity to interview you about: the nature of your disability and treatment; the specifics of your job; and your activities of daily living. You should therefore prepare yourself before making the call. If they call you, you should ask if you could call them back so that you have an opportunity to gather your thoughts. You should be courteous and forthright. But, remember no matter how friendly and helpful the claims representative seems, he or she is not on your side. An insurance company makes money by collecting premiums, not by paying out benefits.

The most important question you must be prepared to answer is the following: Why were you able to work yesterday, but not today? This is easy to answer in the case of an accident, but not in the case of a progressive illness. Often, an individual becomes slowly and progressively more impaired until they reach a point when they just cannot work any longer. This must be explained to the insurer.

For more information on applications for long term disability benefits, please see the obtaining benefits section of our website.