Some people honestly believe that if they are transparent and honest, their long-term disability adjustor will pay their claim. Unfortunately, that is usually not the case.
Following are actual examples of things we have heard clients say to their adjustors, few ended up actually derailing their claim. It is good to be transparent and honest with your ERISA attorney but not necessarily with your long-term disability adjustor.
Here are 10 things NOT to tell your long-term disability adjustor:
- My mom is very sick, and I have to care for her. (Read by your long-term disability adjustor to mean: “I am claiming disability because I need money to stay home and care for my mom.”)
- My company has been trying to get rid of me for several years now. (Read by your long-term disability adjustor to mean: “my company has a problem with me, so claiming disability is the easy way out for my company.”)
- I don't get along with my boss. (Read by your long-term disability adjustor to mean: “I'm tired of having a fight at work, so I'm claiming disability to get away from my boss.”)
- My son is on the traveling baseball squad. (Read by your long-term disability adjustor to mean: “I need to claim disability, so I can travel and see my son play baseball.”)
- I am flying cross-country for seven hours to visit my sick dad. (Read by your long-term disability adjustor to mean: “I can't sit for four hours at work, but I can sit seven hours on a jet.”)
- I am going on a cruise to Jamaica. (Read by your long-term disability adjustor to mean: “I may be too poor to go on a cruise while I'm working for that insurance company, but when I get a big, fat disability check, I'll have enough.”)
- I went to a three-hour concert last night and danced in the aisles the entire time. (Read by your long-term disability adjustor to mean: “I can't stand at work for more than twenty minutes at a time, but I can dance for three hours straight if I am having fun.”)
- I had an accident five years ago and I have been hurting ever since. Now I need disability. (Read by your long-term disability adjustor to mean: “I've been able to work in this pain all this time, so there must be another reason why I am claiming disability now.”)
- My boss added a lot more to my job and made it too hard for me to keep working. (Read by your long-term disability adjustor to mean: “my job is unique and is not a job performed this way by most other employees. Or, I have some personal problems with my boss and she is getting back at me so I want to quit.”)
- Can I get unemployment compensation and long-term disability at the same time? (Read by your long-term disability adjustor to mean: “I am capable of working, which is why I am claiming unemployment compensation. I just want all the checks I can get.”)
There are also some people who like to share information about their life on social media. Harmless comments, without a proper context, are taken as an admission against that person in evaluating their claim. Remember the Miranda warning given to criminals arrested on a television show: “Anything you say may be used against you in a court of law.”
Then there are some people who don't provide enough information regarding a past event allowing the insurance adjustor to read into their statement a wrong conclusion.
There is most often a logical explanation for every one of these statements. The claimant may simply be naïve and transparent believing that will help their claim. However, a long-term disability adjustor is trained to interpret every one of these statements in a manner against the interest of a claimant. If you want to help your case, you certainly want to keep that in mind.
It is always and in your best interest to obtain an ERISA attorney during the claim process to guard against some of these problems.
We have been handling long-term disability claims for over 26 years and the people we have represented have been genuinely disabled under their plan definition of disability. However, a few have hurt their cases making some of the above comments. After 26 years, we have heard just about everything.