Disability insurance claim examiners often bring up the issue of “appropriate care” when questioning benefit claims and often use this same term as an excuse to deny claims. Many claimants do not properly understand this term and how it can be used by the insurance company to manage your disability claim. Older disability policies used to require that a claimant be under the “regular care” of a physician and required little more. As insurance companies seek more control over disability claims and their direction, this policy language has been changed to “appropriate care,” which has a much more stringent definition. Regular care was usually based on a time perspective, ensuring disabled claimants were receiving some sort of recurring medical treatment. The shift to “Appropriate care” has given the insurance companies the liberty to retain their own experts to decide if the claimant’s choice of treatments or physicians is “appropriate” for the condition. 
The motivating factor behind this change is control of your disability claim. If insurance companies have the latitude to decide what care is (or isn’t) appropriate, they can influence your medical care and treatments with the goal being to reduce the length and amount of the claim, either by discounting the medical support presented by the claimant or by making a disabled claimant return to work no matter the treatment risks or if the claimant is actually ready and able. Several factors are taken into account by the insurance companies when determining appropriate care. Knowing these factors and what to look for can allow you to receive the appropriate care from professionals of your choice rather than that dictated by the insurance company.
