The most important aspect of a claim for disability benefits is the information contained within the initial application submitted to the insurance carrier. The application process is complex and most applicants do not realize the manner in which disability insurance companies scrutinize and investigate claims for disability benefits. Our law firm has counseled and guided hundreds of applicants throughout the application process.

An application for benefits must contain specific information and be supported by the proper documentation. The application process involves collaboration between the applicant, the treating physicians, an accountant and any co-workers at the time the applicant became disabled. The disability application requires an applicant’s occupational duties to be specifically broken down into categories and amount of time spent performing each duty must be established. The manner in which this is determined can make the difference between the receipt of total or only partial disability benefits. In order to verify occupational duties, an insurance company will want to analyze the applicant’s tax returns, profit and loss statements, appointment books, and any other documentation that shows the work the applicant has performed during the three years prior to filing a claim and the time period after filing a claim.

Next the insurance company will require the applicant’s treating physicians to submit Attending Physician Statements, which must state whether or not the applicant can perform either the duties of his or her occupation or in some instances, the duties of any other occupation. In addition, the insurance company will either call or meet with the treating physicians in order to discuss the applicant’s claim for disability benefits. We regularly consult with an applicant’s treating physician, so that the treating physician can properly evaluate an applicant’s restrictions and limitations in conjunction with the applicant’s daily occupational duties. Often, disability should not be addressed in a generic sense, but in relation to the applicants own occupation.

While evaluating the applicant’s claim for benefits, the insurance company will usually send out a company field representative to interview the applicant and review any financial documentation in the applicant’s possession. Field representative interviews should never be conducted without the presence of an attorney. How you phrase a response will follow you throughout the claim’s process. In addition, the applicant may be required to appear for an independent medical examination (IME) and a functional capacity evaluation (FCE). In order to protect the rights of the applicant and ensure legitimate testing, we always recommend that these so-called independent medical exams are videotaped and a copy of the report is provided to the applicant upon completion.

Lastly, without the applicant’s knowledge or consent, the insurance company will usually have a private investigator follow the applicant and conduct video surveillance for several days. The insurance company will then send the video surveillance to the independent medical examiner or the claimant’s own doctors in order to determine if the observations in the video are consistent with the applicant’s inability to perform the duties of his or her occupation. We always ask the insurance company for a copy of the surveillance video and to give the applicant’s treating physicians an opportunity to review the surveillance video before any decision is made.

The insurance companies are not entitled to every piece of information they request, and an applicant must be aware of the legal implications of every communication and document requested by the insurance carrier. Insurance companies have a lot of discretion under the terms of a disability policy. They are required to focus on the limitations and restrictions which prevent an applicant from performing his or her occupational duties at the time the disability started. The playing field is not equal. Unfortunately, the insurance carrier is the wolf in sheep’s clothing.

If you are considering applying for benefits or are waiting for a decision, contact our law firm for a free evaluation of your claim for disability benefits.