Dealing With an Aggressive Claims Examiner

When you file a disability claim, your main point of contact with the insurance company is usually a claims examiner who has been assigned to your claim.  These individuals are trained to act as your lifesaver during your time of need, but they’re specifically trained (and sometimes even rewarded) to search for reasons to deny claims and goad claimants into making statements that are not representative of the truth and can be twisted to the insurance company’s advantage.  There are many different ways that the insurance companies try to reach their profit goals, but one of the most obnoxious techniques seems to use aggressive and pushy tactics in the claim departments to force mistakes or cause anxiety and fear that cause claimants to reconsider whether they should even pursue their benefits.  Knowing the fragile state of many claimants when they file for disability benefits, some claims departments capitalize on these weaknesses and manipulate LTD claims process to their advantage.

The first thing a claimant should remember is to always consider the big picture.  Claims for disability benefits are simply business decisions to the insurance company, so claimants should try to approach their claims in the same, business-like manner.  We understand that simple suggestion is much easier said than done – your claim’s intensely personal for you – but you’ve got to try to stay cool.  Claims examiners (unless they have a personality disorder) don’t have a personal vendetta to deny your claim and may be great people outside the office.  Don’t allow yourself to take their actions personally or turn your claim into a “them versus me” mentality.  Staying calm and continuing to logically and methodically work through the claim process creates the best chance for success.  Letting the stress and frustration that occurs in the claim process compromise your arguments allows the insurance companies to capitalize on such mistakes.  In that state of mind, you’re far more likely to say or send something that can come back to haunt your claim.  In addition, don’t try and take it upon yourself to “fix” the claim process or the attitude of your claims examiner.  That’s not your job – nor does it seem like a job you’d want!

With this understanding, there are many tactics to counter and deal with these types of personalities that will help level the playing field with a claims examiner.  The goal of today’s blog post is to educate claimants on some of the tactics disability companies can use and the ways to mitigate them to maintain control of their disability claims.

  1. Understand the reasons for the questions asked or information requested.  The tactics and techniques used by claims examiners and field investigators are all part of a business strategy to allow you to make a mistake when answering questions or to guide you to provide information that will only help the insurance company.  This is one of the reasons we encourage our clients to communicate in writing as much as possible with claims examiners.  This allows claimants to take time and carefully answer the questions completely and accurately as well as preventing the examiner or investigator from continuing down a script to a predetermined conclusion.  By reviewing questions and information requests in the overall context of the claim, you get a clearer picture of the reasons an examiner is asking specific questions or requesting specific information.
  2. Remember the goal of the examiner’s behaviors or actions.  Everyone can have a bad day or be in a bad mood.  But if good days never come, these attitudes may reflect their training to influence claimants to make mistakes in their claims.  It’s really challenging, but don’t allow a claims examiner to “push your buttons” or to get you to lose your temper.  This is another of the reasons we encourage our clients to communicate in writing with claims examiners and to use the experts in our firm as a sounding board for the claims process.  The ultimate goal of an insurance company and its employees is to discover information to delay or deny disability claims and only pay the claims they absolutely have to pay.
  3. Moderate your responses to the examiner’s questions.  Responding to an examiner’s questions is an important and required part of being cooperative in disability claim, so you should carefully provide thoughtful answers even if the questions seem ridiculous.  When responding, try to remain calm and keep the answer strictly factual and the tone as neutral as possible.  Do not elaborate on answers or include information not requested unless a claims consultant or attorney is working with you on the answer.  Many questions seem to have little relevancy to the claim other than to deny benefits.  Claims examiners expect some claimants to react badly, and they use this aggression to coerce answers or information that you otherwise wouldn’t want to give.  Here’s an example that we have dealt with recently: our firm had a client respond in writing to a claims examiner, answering questions that were asked.  As soon as the letter was received, the claims examiner called the claimant, specifically against the written requests of the claimant and physician, and demanded to discuss the answers.  When the claimant declined to talk to the very agitated and aggressive examiner and invited her to send her questions in writing, the demands for an oral interview just disappeared and we never heard about them again.
  4. Confront your issues with the examiner.  Some claims examiners fall into the passive-aggressive category.  That is, they utilize intimidation indirectly and are experts at subverting your reasons for disability.  When a claims examiner says something that is threatening or confusing to you, stop and bring it up with the examiner.  You don’t have to accept intimidation from claims examiners or investigators, and they will only get worse if they think it’s working.  Make it clearly known (and documented) that you’re aware of their behavior and won’t allow it to continue unchecked is often enough to cause the examiner to act more professionally.
  5. Consider the claim scenario from the perspective of the examiner.  Put yourself in the shoes of a claims examiner.  Previous blogs have discussed the situations at some insurance companies where they have systems to reward low claim loss ratios.  The metrics used to manage employees in claim department are inherently biased towards denials and the amounts of money an examiner is able to save the company.  In addition, claims examiners are pressured if they aren’t producing the results the insurance company expects.  This creates a culture where claim supervisors are willing to “manage expenses” and cut corners to deny legitimate claims, betting that many claimants won’t have the energy or knowledge to get their claims approved.  Having a claim denied doesn’t necessarily mean that the claims examiner didn’t see the merit of the claim, just that the experience, training, and guidelines of the claims department dictates that the claim fits the profile of claims that have been successfully denied in the past.
  6. Trust more what claim examiners write and do, rather than what they say.  Claims examiners will say many things to allow them to appear empathetic about your situation.  They’re looking to create an environment where you’ll trust them personally and let your guard down.  Pay attention to not only what the examiner asks for but also the underlying reasons.  Claims examiners can come up with valid reasons for every question and every piece of information requested, but the reasons given are rarely the complete truth.  Our firm has caught insurance companies obtaining medical records without authorization and then having to scramble and ask for the records again to cover up the breach of privacy.  Take everything an examiner says with a grain of salt, and always look for and understand any ulterior motives for the request.

Following the above suggestions will help deal with heavy handed claims examiners.  This isn’t an all-encompassing list, as  every claims examiner is different, and the methods used vary from examiner to examiner and company to company. Recognizing some of the techniques used by insurance companies to avoid or delay paying disability benefits can help claimants avoid those traps.  Dealing with claims examiners (and especially those who are passive-aggressive) can be extremely frustrating, but keeping your negative emotions under control is vital to the ultimate success of your claim and also, more importantly, your recovery.  The dark intention of some insurance companies is to increase the stress of the claims process to reveal “the truth” they want.  Don’t let them get under your skin and succeed in their goal.  Stand up for the rights in your policy contract and don’t accept the actions of an overly aggressive claims examiner, supervisor, or department.

If you’d like to discuss specific problems with your claims examiner or have any further questions about your disability claim, please call our offices toll-free at (855) 828-4100 or visit our website to sign up for a free consultation.  You can also leave any questions or comments in the comments section below.

3 thoughts on “Dealing With an Aggressive Claims Examiner

  1. Pingback: 6 Potential Pitfalls of Your Chronic Back Pain Disability Claim | Royal Claims Advocates

  2. Pingback: 10 Ways to Protect Your Disability Claim in 2013 | Royal Claims Advocates

  3. Pingback: Medical Disability Durations & The Effect on Return to Work Guidelines | Royal Claims Advocates

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