Two Tricky Ways Disability Insurance Companies Try To Deny Policyholders Benefits

28 September 2018
 Categories: Law, Blog

When you spend years paying the premiums for your disability insurance, it's natural to expect your provider to pay out when you submit a claim. Unfortunately, insurance companies are notorious for putting profits over people and will often look for ways to deny claims rather than pay policyholders their benefits. Here are two ways this can happen with a disability claim and what you can do about it.

Claim You're Addicted to Your Meds

Unless you have an exception of some kind, disability insurance policies will not cover conditions caused by substance abuse or addiction. If the policy does allow coverage for this disease, policyholders are typically subjected to a waiting period where claims aren't paid until they've had their policies for a certain amount of time (e.g. 24 months).

However, even those who've never touched alcohol or illicit drugs a day in their lives may still be subjected to this rule. Some insurance companies will look to see if patients were prescribed commonly abused medications (e.g. Vicodin, Oxycodone) and try to pin their injuries on the use of those prescription drugs or claim the patients overused the medicines, making them ineligible for coverage.

It may seem impossible an insurance company could get away with such an outrageous tactic, but it happens all the time, and usually to people who don't know their rights and/or aren't represented by attorneys. To avoid being taken advantage of this way, make sure you keep records showing you're following your doctor's directions regarding your medication.

Claim Something Is a Pre-Existing Condition When It Isn't

Another trick some insurance companies do to deny claims is to state the disability is the result of pre-existing conditions, which typically aren't covered or subjected to a waiting period. For instance, if you have diabetes, the insurance company may blame the stroke that disabled you on that condition and deny coverage.

This type of denial can be tough to overcome because some diseases do increase your risk of adverse disability-causing events. Your best strategy in this situation is to try to put as much distance between your medical condition and what caused your disability.

In one case, for instance, a woman developed preeclampsia during her (up to that point) healthy pregnancy. After giving birth, the woman suffered a stroke. Her insurance company denied her disability insurance claim, essentially stating her pregnancy was a preexisting condition that contributed to her stroke. The woman eventually won her case by showing the insurance company was being unreasonable by connecting her pregnancy with her stroke via the preeclampsia she developed because only a small percentage of women develop the condition and her pregnancy had been otherwise healthy up to that point.

There are many ways you can defend yourself against these and other tactics your insurance company may take to deny your claim. Contact an attorney for disability insurance claims for more assistance.