kotak: how to handle aggressive push back from your long-term disability insurer
3 minute read
many insurers are already making a record of your conversations with their employees, but it’s a good idea to keep your own version
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when a worker is forced off the job by a medical issue, the recovery period is often a lonely one, so it’s understandable that long-term disability claimants may feel a connection to their point person at their insurance company.
on the surface, it could seem as though you share a common goal, but the reality is that the claims adjuster’s ultimate duty is to their employer: the insurer.
all too often, the relationship deteriorates over time, as the claim adjuster’s true allegiance reveals itself. sometimes it can even sink to intimidating behaviour — a betrayal that cuts deeper for claimants who believed they had established a rapport with their claims adjuster — only to realize that person has become a bully.
over decades of experience advocating for injured workers, i’ve seen too many feel bullied and harassed by insurance company representatives asking the same questions — over and over again — about their ability to function or pressuring them into an inappropriate early return to work.
here are five top tips for dealing with a bullying claims adjuster.
1. tell the truth
honesty is always the best policy when dealing with insurance company representatives. as invasive as it may feel to answer questions about your medical history and day-to-day activities, claimants are always best served by straightforward, truthful answers.
in some cases, insurers hire investigators to follow claimants in an attempt to catch out those who are exaggerating or stretching the truth. but even without the threat of surveillance, you don’t want any of your actions to be seen as misleading, since judges do not look kindly on claimants who fail to be open or honest if the matter ever goes to court.
2. file a complaint
just as you might with an irritating neighbour, try to keep relations cordial to keep the peace and maintain professional conversations.
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however, if a claims adjuster’s conduct is truly untoward and edges into harassment, you should not have to put up with it. do not be afraid to ask for their manager’s name or escalate your concerns to his or her superior, if necessary.
alternatively, every ltd insurer has some form of ombudsman or complaints department where you can express your dissatisfaction with your treatment. at the very least, this will ensure that someone else at the company gets their eyes on your file, so that you are not going one-on-one with the claims adjuster.
3. keep records
many insurers are already making a record of your conversations with their employees, but it’s a good idea to keep your own version, even if it’s just a few notes concerning what was discussed during each call.
in appropriate cases, courts have the ability to award punitive damages to punish bad-faith conduct in the handling of an injured person’s case. if you’re uncomfortable with a request that a claims adjuster makes of you on the phone or a persistent line of questioning, ask the adjuster to put it in writing.
if the person fails to follow up, you may want to email them yourself to ask for clarification or confirmation regarding your understanding of what was asked.
4. tell your doctor
unfortunately for many injured workers, inappropriate or bullying interactions with their ltd insurers exacerbate their health problems — particularly those dealing with psychological conditions such as anxiety, depression, post-traumatic stress disorder or obsessive-compulsive disorder.
make sure your family physician and other medical specialists you consult know about any pressure insurance company representatives are exerting and how that pressure has impacted you, so that they can adjust your treatment accordingly.
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this could also become relevant if you end up in litigation against your insurer, since extra-contractual damages may be available to claimants who can show that the way their case was handled resulted in mental distress.
5. get a lawyer
if your ltd claim is ultimately denied or your benefits are terminated, or you feel pressured into making an early return to work before you are ready, let your lawyer know about everything that went on during the claims-adjustment process. your legal counsel can make appropriate requests for records from both the insurer and your treating medical professionals, and possibly draft a claim to target any inappropriate behaviour.
nainesh kotak, is the founder of kotak personal injury law, a firm focusing on protecting their client’s rights to justice and obtaining the compensation their clients deserve. he also serves as the chair of the long-term disability section of the ontario trial lawyers’ association.
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