Is My Long Term Disability Claim in Danger of Being Denied?
The Insurance company has many tricks and tactics they use to deny your claim. By changing a few words, the insurance company uses an alternate, vague definition to of essential terms in the policy to exclude you. It's not right, but it happens all the time. Filing a disability claim is like hitting a moving target. If it's not one thing they are using to deny your claim, it's another. One tactic disability companies use is changing the definition of disability or using a vague definition of disability in your policy and then excluding your condition.
An example of this in practice is when a denial letter says "a claimant is disabled if they are incapable of performing all of their essential job tasks." However, your policy says "a claimant is disabled if they are incapable of performing at least one of their essential job tasks." So they use a phrase that's not even in your policy to exclude you from benefits. And who would notice that?
The insurance company is hoping you won't notice this switch-a-roo, and you will be too frustrated to push forward with your appeal. Denying claims at the outset is one of the tactics insurance companies use all the time in order to keep their claim rates down. Oftentimes it takes getting an attorney who isn't intimidated by these tactics to move forward with your case.
This subtle shift in language is why it is essential to consult with an experienced disability attorney about your claim. Vague definitions are one tool the insurance company uses to deny your claim, but there are many more they can use. An experienced ERISA disability insurance attorney will know what to do with these tricks and vague definitions.