Delayed Claim Approved After Di Law Group Attends Field Interview

As noted in some of our previous blogs, insurance companies often require an in-person or telephone interview with a claimant either prior to making a claim determination or during the ongoing evaluation of a claim that is being paid. The goal of the insurer’s interview is not simply to better understand their insured’s claim, but to acquire information that can be misconstrued or taken out of context -and ultimately used to further delay or deny the payment of benefits. In many cases, the insurance company has provided the interviewer with specific information it considers problematic and has instructed the interviewer to delve into these issues. Most of the time the red flag issues are not openly acknowledged, but rather addressed in an indirect manner. Thus, rather than providing the insured with the opportunity to directly explain any alleged problems or inconsistencies, the interviewer asks indirect questions hoping to elicit information that can be used to deny benefits. Examples of red flag issues include information from a tax return, information obtained by looking at corporate filings, pictures or comments posted on an insured’s social network page, surveillance video footage, and information (or the lack of information) within a set of medical records.

At Disability Insurance Law Group, we do not allow our clients to attend an in-person or telephone interview without our presence. We fully prepare our clients for what they will face prior to the interview; limit the interviewer’s ability to ask ambiguous and unfair questions; clarify a response where necessary; and make sure all essential and relevant information is conveyed during the interview. Additionally, because we are familiar with insurance company denial tactics   and have attended hundreds of field interviews with our clients, we are able to determine the red flag issues and provide clarification and correct information. Recently we were hired by an individual who for months had been sending information to the insurance company in support of her claim. Despite clear statements from her doctor that she had significant vision loss and was considered legally blind, the insurance company continued to question her inability to work as a pharmacist. When four months into the claim she was told that a field interviewer would be coming to her home to speak with her, she hired Disability Insurance Law Group to get her claim resolved. The first thing we did was advise the carrier that one of our attorneys would attend the field interview with our client and that the interview could not take place in her home. During the interview, there were numerous questions about her tax returns, activities involving her son, and her medical treatment. Additionally, the interviewer frequently offered her a response to his questions in an attempt to elicit misrepresentations and ambiguous responses that could be misconstrued by the carrier. Our attorney clarified many of our client’s responses to make sure the information was accurately conveyed to the insurance company and insisted that the interviewer explain the reason behind some of his dubious questions. It ultimately became clear that the insurance company questioned our client’s disability – even going so far as to suggest that she did not have vision loss, and that she could return to her occupation but preferred to take care of her son and live with her parents (with whom she was forced to live because she could no longer afford her home without an income or her disability benefits).

We subsequently provided indisputable evidence of her disability, personal statements from family and friends and threatened a law suit if the claim was not immediately approved and a check sent to our client for all benefits owed to date. Within the week her claim was approved and benefits paid. Without our involvement it is quite likely that the claim review process would have dragged on for several more months and many of her responses (such as, “the one upside to not being able to work is the opportunity to spend more time with my son”) would have been misconstrued and the basis for a claim denial.

If you are considering filing a claim for disability insurance benefits, currently in the process of a claim review or have had your disability benefits denied, please contact us for a free consultation. You can reach us toll free at (954)-989-9000 or through our website www.dilawgroup.com