It is not illegal for an insurance company to conduct surveillance. In fact, it is a common tool used during the adjudication process. Insurers believe that surveillance provides more accurate unbiased information of functional abilities as the insured is unaware that they are being observed.
Insurers can conduct surveillance from outside your home. Investigators hired by the insurance company can follow you during the course of your day. They cannot enter a home or plant recording devices or tracking devices. They can take photographs and video footage of you, as long as it is not in your home. The best way to deal with surveillance is to be honest and consistent with your doctors and the insurance company. The insurer may also follow what you post on social media and on the internet to look for inconsistencies and credibility issues.
They may look for websites that have you listed or they may be checking to see if you are operating a small business from home. We have heard the argument from insurers many times that if our clients are out and about, as seen on surveillance or active on social media, then they are able to function in the workplace and earn a gainful income.
There are a multitude of reasons why this may simply not be true. The lawyers at MK Disability Lawyers LLP have dealt with and successfully contested denials and terminations based on all of the above reasons and many more.
If your claim has been denied or terminated, please do not assume that the insurance company is correct in denying or terminating your claim. There may be many reasons why their decision may be inaccurate and can be contested. If you feel that you have not been treated fairly by your long term disability insurer and would like to discuss your long-term disability claim with an experienced lawyer, MK Disability Lawyers LLP are experienced lawyers dedicated exclusively to the practice of disability insurance litigation.
We would be happy to provide you with a free consultation. Please contact us online or by calling us at The preceding is not intended to be legal advice. This blog is made available for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog, you understand that there is no solicitor-client relationship between you and the blog publisher.
The blog should not be used as a substitute for competent legal advice from a licensed lawyer in your jurisdiction. If your disability claim has been denied and you require legal advice, contact a lawyer specializing in disability law. All Rights Reserved. Privacy Policy and Disclaimer. Website designed and managed by Umbrella Legal Marketing.
Has the insurance company carefully reviewed my claim? Are other claims being denied for the same reasons my claim was denied? Are there common reasons why long term disability claims are denied?
Reason 2: Failure to Communicate with the Insurer Many claimants believe that once they have provided initial claim documentation to the insurance company they no longer have to communicate with the insurer. Reason 3: Contractual Reasons such as Pre-existing Condition Exclusion Clauses An insurance company might deny benefits on the basis of a contractual exclusion.
Erreca v. States Life Ins. Thus, your disability plan administrator cannot terminate your disability benefits based on your alleged ability to perform a minimum wage job if you were previously employed in a professional capacity. Likewise, if you possess a high school diploma and no relevant work experience, your disability plan administrator cannot deny benefits based on your alleged ability to perform occupations that require a college degree or trade school diploma.
Thus, even if you are totally disabled and overcome all of the other claim hurdles discussed above, your benefits could be terminated if the plan administrator determines that your disability is caused or contributed to by a limited-duration benefit condition. You can overcome those policy limitations by establishing that you are independently disabled due to a non-limited condition, but this can be difficult.
See Krolnik v. Prudential Ins. The burden of proving the applicability of policy limitations is on the plan administrator. If your disability claim is denied, you have the right to appeal.
In fact, if your disability claim is subject to the federal ERISA statute, you must appeal the denial in a timely manner, since failure to do so could later bar you from filing suit.
Under ERISA, your disability plan administrator is required to notify you of an adverse benefit determination in writing and provide you with at least days to appeal or, in some cases, as little as 60 days. You have the right to request a copy of your claim file and the underlying plan documents. You should consult the denial letter and policy or plan document to confirm.
Alternatively, you may proceed directly to court. There is no requirement that you hire an attorney to assist you with appealing a disability claim denial, but an experienced disability claim attorney can help maximize your likelihood of success, both during the appeals process and in any subsequent litigation.
In the case of disability benefit claims subject to the ERISA statute, you may not get an opportunity during litigation to supplement the claim file developed during the pre-suit appeal process. Thus, it is critical that the claim file be fully developed. An experienced attorney will request the claim file and plan document to confirm that the plan language quoted in the denial letter is accurate.
The attorney will identify what additional evidence, if any, is needed to perfect your disability claim. The attorney may suggest additional testing, such as neuropsychological testing or a functional capacity evaluation, to help prove your disability claim. Acceptable nonmedical excuses. It is possible that you cannot follow a prescribed therapy for a reason that has nothing to do with your medical condition.
Acceptable nonmedical excuses for failing to follow prescribed therapy follow. Additionally, for the SSA to deny your claim for failing to follow therapy, the therapy that you fail to follow must be one that is clearly expected to restore your ability to do substantial gainful activity. If your treating doctor tells the SSA that the prescribed therapy is not likely to result in your ability to work, the SSA won't fault you if you don't follow such therapy. For more information, see Nolo's article on the impact of failing to follow prescribed treatment.
The SSA will deny benefits to someone whose drug addiction or alcoholism DAA is a contributing factor to his or her disability. The key factor a DDS medical consultant must consider when making a DAA determination is whether or not the SSA would still find you disabled if you stopped using drugs or alcohol.
For more information, see Nolo's article on when drugs or alcohol will prevent you from getting disability. Certain conditions related to conviction of a crime or imprisonment will prevent you from receiving Social Security disability insurance benefits.
They are as follows. However, it's worthwhile to apply for SSDI benefits even if one of the above situations apply to you, because even if you can't get cash benefits, you may be granted a period of benefit-free disability that will "freeze" your earnings record , keeping your eventual disability, retirement, or dependents benefits from decreasing.
Note these situations do not prevent you from receiving SSI disability benefits, although being incarcerated does keep you from collecting SSI benefits. If you obtain disability benefits by dishonest means, the SSA can terminate your benefits and prosecute you for fraud. If you obtained benefits through fraud on the part of someone working for the SSA, your benefits can also be terminated. Morton III, M. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site.
The attorney listings on this site are paid attorney advertising. In some states, the information on this website may be considered a lawyer referral service. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. Grow Your Legal Practice. Meet the Editors. You Earn Too Much Income For SSDI, which is the benefit program for workers who have paid into the Social Security system over multiple years, one of the most basic reasons you could be denied benefits is that, when you apply, you are working above the limit where it is considered " substantial gainful activity " SGA.
You Refuse to Cooperate Your medical records are vital to granting your disability. You Fail to Follow Prescribed Therapy If you are being treated by a doctor, but fail to follow the doctor's prescribed therapy when you have the ability to do so, you can be denied disability benefits.
You have a mental illness so severe that you cannot comply with prescribed therapy. You have a fear of surgery so intense that surgery would not be appropriate. Your treating doctor must confirm the severity of your fear to the DDS consulting doctor.
You physically cannot follow prescribed therapy without assistance—for example, because of paralysis of the arms or cataracts caused by diabetes. You don't have the money to pay for treatment.
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