How to Protect Your Long-Term Disability Claim from Denial

A common thread in disability claims is how active the individual is after filing their claim. Insurance companies require claimants to complete detailed forms describing their activities, asking them how they spend their day from morning to evening, what computer systems they use, even how often they watch TV.  It is important to understand that the real reason insurers want this information to prove that you are doing activities that suggest you are more functional than reported, or to identify an alternative job you can perform, so they can deny your claim.

Our clients ask us whether they need to suspend all of their social interactions, and give up gym memberships, etc. because they have a pending claim. The answer is a qualified “no”.  However, your activities post-disability must match your declared limitations. For example, if you claim that you cannot sit for long durations, traveling by air to Hawaii would create a question related to your ability to sustain siting.

In a case currently under review in our office, an individual suffering from Long COVID attended a family wedding, as noted by her doctor in her record.  The company denied the claim for several reasons, including its allegation that our client could not be that disabled since she went out and socialized. What they intentionally left out is the doctor’s note that indicated that our client was terribly fatigued for days after the wedding.  We represent another individual whose insurance company incredibly asserted that his disability could not be that bad because he was able to attend doctor and therapeutic visits.

A recent Court example involves a physician who could no longer able to perform the specialty duties of her occupation, but could participate in social and recreational activities.  Kieserman v. Unum Life Ins. Co. of Am., 2021 U.S. Dist. LEXIS 233200 (W.D. Wash. Dec. 6, 2021). As this case demonstrates, if the policy provides coverage for the claimant’s “own occupation”, then her activities outside of the demands of her profession should not matter.

Dr. Kieserman was an emergency physician disabled by the symptoms and treatment side-effects of Stage IV metastatic breast cancer. Unum alleged that since she was “able to vacation in Europe skiing in the Alps with [her] family”, and had been “exercising and doing sweaty Yoga[.]” her claims of fatigue interfering with her work were not supported.  The District Court for the Western District of Washington disagreed, finding Unum’s focus on Dr. Kieserman’s activities to be “misplaced.” The Court noted that Dr. Kieserman had been instructed to exercise by her treating physician “in order to achieve optimal treatment outcomes” and found that her activities did not contradict her claim that she could not return to work full time.

If you are currently receiving disability benefits, or are thinking about filing a claim, stay mindful of your policy and adhere to the restrictions and limitations set by your treating physician(s). Refrain from posting your activities on the internet.

We at Bonny G. Rafel LLC, provide legal counsel to individuals seeking long term disability benefits, and advocate for our clients as the Voice of the Disabled.  See our website for video presentations and information on our boutique practice and contact us to discuss your case.

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