As one of the leading causes of long term disability, insureds who have suffered a stroke are some of our most common clients. Almost 75 percent of individuals who experience a stroke suffer lasting symptoms that reduce their work capabilities. Between 15 and 30 percent of individuals who have suffered a stroke become permanently disabled, experiencing impairments such as paralysis, sensory disturbances, language issues, memory problems, and emotional disturbances. Survivors who unfortunately experience these symptoms are often unable to continue in their profession, or any profession, and then face having to file a claim for disability insurance benefits. As we have seen time and time again, this is where new problems begin.
Since many people seemingly make a full recovery from a stroke, insurance companies often use these cases as proof that stroke victims can return to work or that the restrictions and limitations are instead caused by mental illness, which can reduce the benefit period. The abilities of stoke victims can change often and unpredictably. People may regain sensation in a hand that they haven’t had since their stroke or begin to walk after confined to a wheelchair. Conversely, strokes may also cause new complications and functional losses years after the event.
The wide ranges and levels of impairments suffered by insureds after a stroke creates opportunities for claim departments to creatively investigate and vigorously defend against such claims and find reasons to reduce or deny the disability claim. Insureds are counting on but can’t collect their insurance benefits.
The following points describe a few scenarios our clients have found themselves in and how to protect yourself from the underhanded traps of the insurance companies.
- Capitalizing on simple mistakes: Most claim examiners don’t have evil intentions to go after insureds and take advantage of their condition. Rather, it’s the lack of time, knowledge, and concern about the insureds and their impairments caused by an overly aggressive management philosophy that causes many problems. Stroke victims often have trouble relaying their thoughts and forget relationships between words, actions, and objects. They can have difficulty communicating, in terms of expressing or understanding speech or written words. This leaves a lot of room for errors on their claim forms and in their communications with the insurance company. Insurance companies provide little help completing these forms, nor are they obligated to do so, but claim forms and communications can also be made confusing for a reason. No one likes the feeling of losing their abilities or independence, so they’ll try to complete the forms and handle the claim adjudication process on their own, unknowingly damaging their claim. No matter how confident in your abilities, it’s important to let a loved one, family member, attorney, or disability claims consultant review your claim forms prior to submission to make sure they are accurate, clear, complete, and free of mistakes.
- Transitioning the disability to a mental and nervous condition: It’s well known that strokes cause cognitive impairments and emotional disturbances in many victims. Insurance companies will often try to capitalize on this and characterize the reason for the inability to work as being due to mental conditions while downplaying or even ignoring the stroke. Make sure that your treating physicians clearly describe how your stroke caused your physical impairments, that resulted in the restrictions and limitations, that prevent you from working. Try to take time to discuss with them the issues your physical impairments cause in your day-to-day work and make sure that information is received by the insurance company.
- Manipulating the job description: Many LTD insurance policies have a definition of disability that changes from “own occupation” to “any occupation” after a period of time, usually two years. This two-year period often coincides with the demanding and stressful immediate rehabilitation period for stroke victims, when they’re less likely to be able to complete basic tasks and when the approval of their disability claims are most common. Insurance companies will use this time to quietly evaluate the insured’s job description so that when the policy definition changes to “any occupation,” it’s easier to deny benefits using vocational experts and other reports to show that insureds can work in another job in the national economy based on their education, training, and experience. It’s vital that you pay attention to what the insurance company is requesting, what they write or say, and how they’re using that information, even if your disability claim seems like a certainty at the time. Insurance companies are always looking for a way to “resolve” the matter by delaying your benefits or closing your claim.
Stroke victims have enough to worry about without needless concerns about their disability insurance benefits. Watching for a few specific red flags and following the suggestions made here will help ensure that you or your loved ones won’t have to worry and fight for the benefits you rightfully deserve.
Insurance companies and claim departments are managed by sharp business executives who didn’t rise to their positions by making unprofitable business decisions. They’re always looking for ways to stay ahead of the competition, which can include making more money through claims management. Too many executives don’t see insureds as people but rather as markets and statistics. With decades of experience, our experts know the disability claims industry and can help ensure a smoother, less stressful claims approval process. Please visit our website for a free consultation or call our offices at (855) 828-4100.