Insurance is tricky; the words your disability company uses in your policy often need explanation and illustration. Level the playing field by learning about the top ten denial tactics insurance carriers use and how to avoid them in your individual disability insurance claim.

1. MISTAKES
10
TO AVOID IN
INDIVIDUAL
DISABILITY
INSURANCE
CLAIMS01

2. AVOID THE "FRAUDULENT
MISSTATEMENT" PROVISION.
Information can be misheard, misunderstood or
inaccurately recorded when relayed to the
insurance company. Before you file, closely review
the medical, occupation and financial information
to flush out anything that was inaccurate or
misleading.
1If the insurance tries to rescind your policy, DO NOT cash the
recission check!

3. CONFUSION ABOUT POLICY
LANGUAGE.
Most policyholders don't pay close enough
attention to the fine print, so be careful.
Carriers love to argue that you really have a
dual occupation at the onset of the claim and
therefore never qualify for total disability.
2

4. FAILURE TO PROVIDE
OCCUPATIONAL DEMANDS.
Arm your treating doctors with all the
information they need to answer the
insurance carrier's questions about the
physical and mental demands of your work.
3

5. POSTING ON SOCIAL MEDIA.
4Facebook, Twitter, LinkedIn and Instagram
updates document happy events in our
lives, but rarely reflect the realities of a
disability. Know that your carrier is watching
your Internet activity and that posts about
your activities will jeopardize your claim.

6. UNDERSTATING YOUR
ACTIVITIES ON CLAIM FORMS.
5
What you say on your claim forms will be
used against you. If you say you can never
lift more than five pounds or you’re never
able to sit for long, plan on your carrier
sending out the “paparazzi” to videotape
your daily activities. When filling out your
forms, don’t use the words “always” or
“never.” Be as accurate as possible.

7. PROVIDING MORE
DOCUMENTS THAN REQUIRED.
6Often, carriers will try to ask for
documentation that policyholders aren’t
legally obligated to provide, such as tax
documents. Only give what’s needed and
seek out an experienced disability attorney
if you’re uncertain about what’s required.

8. EXACERBATING YOUR
CONDITION DURING A FUNCTIONAL
CAPACITY EVALUATION.
Many policyholders push themselves to do their
best during a functional capacity evaluation
(FCE), but you should only perform what can be
done safely. You should also be vocal about your
pain on a scale of 1-10 as the exam progresses.
7

9. ALLOWING YOUR PHYSICIAN
TO SPEAK TO THE CARRIER'S
ON-SITE PHYSICIAN.
8This is a recipe for disaster and no policy
requires this step. Instead. ask for the
on-site physician to send your doctor the
questions in writing, so that after careful
reflection, no mistakes are made.

10. FAILURE TO DISCLOSE
PRE-EXISTING CONDITIONS.
9If your carrier can't take away your policy for
fraud, and your disability began within two
years after purchase, the next best carrier
defense is arguing that anything you failed
to disclose is a pre-existing condition.
If that strategy fails, the carrier will look for care or treatment
during the pre-existing period to deny benefits.

11. DECIDING TO APPEAL
WITHOUT PROPER COUNSEL.
01
After a denial letter is sent, policyholders
generally have a right to appeal. This is a
difficult decision and can mean the
difference between bringing a bad faith
claim and giving the carrier the
opportunity to fix the unreasonable claim
handling.
Seek an experienced, top-rated disability lawyer to help answer
this important question.

12. FOR MORE INFORMATION
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