One issue I do not believe many claimants correctly understand is the issue of who has the burden of proving your Short Term Disability or Long Term Disability claim.
The simple answer to this question is generally found in the insurance policy. My experience over the many years I have been handling these claims is that these policies put the burden of proving the claim on you, the claimant. A court of law would uphold such a clause.
Indeed, if a cause of action was filed to enforce the obligation to pay benefits, the claimant would be the Plaintiff who always has the initial burden of moving forward to prove the claim. These legal niceties present no concern for us as we continually build our client’s claim from a strong basis to the highest and best result that can be achieved.
Harassment Of Physicians
In other writings, I have addressed the issues arising from claims representatives engaging in a harassing course of conduct inflicted on treating physicians and their staff. The problem is this – the insurance companies Aetna, MetLife, New York Life, Reliance, Standard, Prudential, Unum, Paul Revere, Hartford, Sedgwick, Lincoln, Symetra, and Mutual of Omaha instruct their claims representatives to lead the claimant to believe they will find the medical and other documentation necessary to build the claim.
Hundreds of times, clients have told me that the doctor says he sent the records, but the claims representative denies receipt. Other tactics include constant calls for the doctor’s immediate attention to inquiries based on artificial deadlines. This course of conduct is clearly designed to cause your treating physicians, the ones most familiar with your medical condition, to become unwilling to participate in the proof of the claim. Without such cooperation, evidence of the claim is practically impossible as medical records alone will not suffice, and claimants do not have subpoena power to set depositions to secure the doctor’s testimony.
Our Approach
Our approach is as follows. When we become involved, no further direct communication is allowed between the insurance company, its agents or hired-gun doctors, and your treating physicians. If the claims representative wants something from a treating physician, a written request comes through our office.
We operate in this manner so that we are aware of the timing and contents of the communication. We then pass it to the doctor and follow up for a response. More importantly, the response comes through our office before we contact the insurance company. This allows us to verify the accuracy of its contents and keep a copy of the specific item which went to the insurance company. It is transmitted in such a way that the claims representative cannot deny its receipt.
Oral Communication
Oral communication with a claims representative is relatively useless except in unusual circumstances. Everything has to be done in writing. My clients sometimes review the claims files and find that the notes made by the claims representative of a particular conversation bear no relation with what actually occurred. It all has to be in writing. It does not need to be an argumentative type of presentation, just a simple “Here this is,” or “Please explain that,” or “What else do you need?”
We Represent You
I cannot reiterate enough that there is no “buddy-buddy we’re working on this together” relationship with the claims representative. They are doing a job designed to deny you the benefits to which you are entitled. Your economic life may be threatened, but for them, it is just a career they are trying to advance. If they act buddy-buddy, it is just one tactic to get you off guard.
Your Short Term Disability or Long Term Disability claim is just about all we do here at Herbert M. Hill, P.A. We know the benefits you are entitled to and how to get them. After discussing your case, we can set up a conference in our office or on a Zoom call, whichever works best for you. Contact us for more information.
