How to Handle the Carrier’s Stalling Tactics and Delay In Making A Decision On Your Disability Claim Or Paying Your Continuing Disability Benefits
It isn’t uncommon for an ERISA or private disability carrier to stall and delay in making a decision on your claim or to pay your continuing disability benefits. After all the carrier is in the business of investing your premium dollar and not paying benefits.
An insurance company has a contractual obligation to determine if you are and remain eligible for disability benefits. Unfortunately, not all policies have a time period in which they must make a decision. The carriers use their contractual obligation and lack of decision deadlines as weapons!
We Need More Information
It is all about paper, paper and more paper! The carrier may say they need more forms filled out, more medical reports, more information about your activities of daily living or other money you may be entitled to as a result of your disability. They may ask you for a release so they can get a copy of your Social Security Disability file. Worse yet, they may want to take your statement or have you evaluated by the “independent” medical evaluator.
The disability insurance company may even have their peer review medical physician or IME physician contact your physician to comment on the carrier’s medical conclusions. This causes further excuses from the carrier and delay under the guise of making a “full and fair review” of your case.
The policy does require you to cooperate but there is a practical limit as to what they can request. For example, the carrier can’t ask for your spouse’s income tax return unless you are in business with them.
If the carrier asks for more information, send them a certified return receipt requested letter asking for a complete list of what information or forms they require and request they give you a deadline for making a decision. Remember an ERISA carrier has 105 days to make a decision.
Unfortunately, in the ERISA world you have to “exhaust” the administrative process before you can say “I have had enough delay, I’m going to sue!” More likely, you will feel exhausted by this process.
Our rule of thumb in a private disability case is to give the carrier 90 days in which to make a decision. That can be longer on a case by case basis.
During this time, Attorney Cavey is in contact with the carrier answering their questions, providing them with information as requested and pushing them to make a decision.
We Never Got What You Sent Us (Despite the Fact I Sent It E-mail, Fax or U.S. Mail)
Carrier’s ask for all sorts of information and then claim they never got what you sent them. You should make a copy of everything you send the carrier and send it via fax, e-mail and regular mail return receipt requested. Keep proof of everything you have sent the carrier!
We Want To Take Your Statement
You are being set up for a possible claims denial. Why? The carrier might have surveillance on you or want to ask you questions that will be the basis for a claims denial. This is not a social call! It is time to immediately hire Nancy L. Cavey who will prepare you for your statement, be with you when your statement is taken and give them a deadline to make a decision!
We Want You To Be Examined By An Independent Medical Examiner Or Undergo A Functional Capacity Evaluation
Disability carrier’s willing pay lots of money to physicians or FCE providers who will say:
(1) there is no objective basis for your diagnosis,
(2) your doctor is all wrong about your restrictions and limitations,
(3) your treatment is not sufficient,
(4) your complaints are all subjective and not believable and
(5) you can work.
This is not an independent medical examination or FCE! It has been bought and paid for by your disability carrier. It time to immediately hire Nancy L. Cavey who will make sure that your interests are protected at the examination!
If Your Carrier Isn’t Making or Is Delaying Making A Decision on Your Claim It Is TIME To Hire Nancy L. Cavey
If you want to get paid, it is crucial to have ERISA/ID disability attorney Nancy L. Cavey deal with the carrier’s stalling tactics.