When You Are Disabled, Be Careful What You Say To The Insurance Claims Handler
Attorney
(866) 735-1102 Ext 645
Eugene Andersons the dean of the claimant's disability insurance bar.
For many years, Mr. Anderson has fought diligently for the injured person and has won many battles on behalf of his clients against disability insurance companies who wrongfully deny benefits to their insureds.
In a recent article published for the insurance law section of the American Association for Justice, Mr. Anderson warned against the bias written into claims notes of conversations with disability insurance claimants. These claim notes are written to record conversations that disability insurance claims handlers have with disabled policy holders.
Mr. Anderson points out that while these notes may not always be totally false, they only tell half truths and are heavily slanted in the insurance company's favor by creating the false impression that the health condition of the disabled insured is much improved and that his disability has ended.
These claim notes, unfortunately, become part of the claims file which the courts construe as business records, giving them a sort of sacrosanct status.
The danger is that these notes may be viewed as the gospel truth by the court in determining whether a claimant is disabled.
That is why Mr. Anderson cautions the disabled insurer to be careful what they say to the claims handler and how their statements are phrased.
As an example, assume the policy holder tells the claims examiner that she has severe headaches in the morning. She says that she feels better once she gets up and about. The insurance company claims notes will reflect merely that the claimant feels better once she gets up and gets going in the morning. Thus, what appears on the claims notes for the court to see contain only half truths.
The woman may claim that she does not feel "up to" going to the doctor again. This will likely be recorded in the claims notes as "does not plan to seek further medical treatment." Her remark that she is too tired to go to the doctor becomes: "tired of going to the doctor." This statement again distorts the import and true meaning of the claimant's statements.
Mr. Anderson points out that insurance company claims personnel write notes that misconstrue the claimant's complaints and minimize their severity. Although the claims handler's notes in the claim files are not false, strictly speaking, they fail to give an accurate and complete picture of the claimant's health and well being. The notes accentuate the positive, but the positive is only half the truth.
Mr. Anderson notes that this accentuating the positive and downplaying or eliminating the negative may go on for a long time and in a variety of settings.
Insurance claim handler's conversations with the claimant's employer may skip over the negative in a way that portrays a disgruntled employee who should be busy at work, rather than at home, with complaints that others may perceive as minor aches and pains.
In later discussions with the claimant, the claims examiner reminds her of her earlier statements: "Didn't you tell us three months ago that you felt better in the morning?" The claimant, of course, does not recall this conversation that may have occurred a year earlier but responds "Yes." She does not challenge the previous conversation because she took no notes and does not remember. The claims examiner on the other hand, has notes which will be a prominent part of the court's file. Since the claims notes accentuate the positive and eliminated the negative that is all that the file now reflects.
This long series of conversations with the claims examiner in which he records only the positive and most favorable aspects of the claimant's health amounts to, in Mr. Anderson's word: "a long term cross–examination."
Eventually the claimant gives up and sues.
The insurance company then defends its denial of the claim on the basis of their claims record which was carefully crafted over a long period of time by a biased and nimble claims handler who has purposely distorted the record.
Before suit is even filed, the deck has been unfairly stacked against the claimant.
You should, therefore, be extremely careful what you say to the claims handler and realize that it is his job to build a claims file which will support a denial of your claim.