Do You Have to Answer Insurance Company Requests for Documents?

When you are filing a claim for long-term disability benefits, it can seem like you spend all your time gathering paperwork. Do you have the right to say no? Or do you have to answer insurance company requests for documents?

In this blog post I will discuss the various kinds of papers and documents that long-term insurance companies ask for when reviewing a claim. I will address when your records may be protected, and what paperwork you should be prepared to turn over. I will also explain how hiring a long-term disability insurance attorney early on can make responding to these insurance company requests for documents easier.

Filing Initial Insurance Claim and “Proof of Loss”

The process of receiving long-term disability benefits starts with the application. Most insurance companies have specific forms that you need to file to begin the claim process. It is important that you fill this claim form out completely and truthfully. Leaving a section blank or providing incorrect information could give your insurance provider the loophole it needs to deny your claim and say you committed “fraud”.

Your application should be supported by proof of your disability, often called “proof of loss”. This could include a statement from you about your disability and what you are no longer able to do, or calendars showing days you have had to take off work and why. However, it should also include objective evidence of your condition, such as medical records or test results. This objective proof makes it harder for the insurance company to claim “it’s all in your head.”

Answering Insurance Company Requests for Documents in Support of Claim

Once your insurance company receives your claim, it will almost always send you requests for documents to support it. This is true even if you have provided thorough proof of loss documentation. The insurance company requests for documents are a tool the company has to find defenses and reasons to deny your claim.

So do you need to answer those requests? It depends on what they are asking for. Except where other laws apply, your long-term disability insurance policy will describe what you are required to provide in support of your claim, or in response to insurance company requests for documents. You generally want to cooperate with your insurance adjuster and provide the information requested unless you are worried that it could threaten your claim or unreasonably invade your privacy. Here are a few of the most common types of records and how you might respond.

Medical Records

Your insurance company will almost always request access to all of your medical records. Your insurance provider has a right to review any medical records related to your disability claim. That may include notes from mental health providers, doctor’s office records, test results, and your prescription history. However, if the records they are requesting are entirely unrelated, you may be able to refuse. For example, records related to the birth of your child may not be relevant to a later Multiple Sclerosis diagnosis. You and your long-term disability attorney may be able to limit the medical records produced to exclude unrelated treatments or records from the distant past.

Your insurance company may also ask you to submit to an “independent medical examination” by a doctor of their choice. A future post will discuss the IME more fully. For now, know that your insurance policy may require you to attend in order to receive your benefits.  However, your long-term disability insurance attorney and your own doctors can work together to make the best of that situation.

Authorization for Release of Information

Rather than asking you to provide medical records directly, your insurance company may ask you to sign an Authorization for Release of Personal Health-Related Information (different companies have different names). You should review this form very carefully.  While it is given to you in the context of getting access to medical records, this authorization usually covers far more. The broadest forms give your insurance company the right to get a wide variety of medical, financial, and work-related documents, and talk to anyone who knows you and your medical condition. Signing that authorization essentially gives the insurance company the right to snoop into every area of your life. Your insurance policy may require you to sign a release and allow adjusters to speak to your medical providers. However, your long-term disability attorney may be able to limit exposure of your private details.

Employment Records and Work History

Your insurance company may also request employment records and documents showing your work history. This is so the adjuster can determine whether your disability makes it impossible to do work in your “own occupation”. You should provide this information.

However, many insurance companies have their own ideas of what it takes to do work compared to the employees actually doing the job. In addition to your job title, you should also work with your long-term disability insurance attorney to put together a complete job description for each of your positions.  This will help when the insurance company inevitably tries to generalize your job to the national economy. You may also want to indicate which responsibilities were made more difficult by your disability. It can be hard to admit that you are no longer able to do your job. But providing this additional information can improve your chances of receiving long-term disability benefits without a long, expensive court battle.

Financial Records and Tax Returns

Many applicants are surprised when insurance companies request information about their finances, including their state and federal tax returns. The insurance company uses this information to:

• Define your occupation based on your compensation
• Ensure you aren’t working while filing for disability
• Find proof that you are doing more than you claim

Federal law gives insurance companies the right to ask for your federal tax returns. However, some states protect their state-level tax returns from this kind of disclosure. Turning over other forms of financial information will depend on the language in your insurance policy, and in any authorization you sign. Talk to your attorney to see what can be done to limit the financial information you turn over to them and protect your privacy.

Providing Supplemental Information Over Time

Even after your initial claim for disability benefits is granted, your insurance company will, from time to time, ask for additional information. You will be required to turn over updated medical records and tax information, and could be asked to attend additional vocational assessments or IMEs to determine that your disability continues.

Your insurance company will also ask your medical providers to complete restrictive Attending Physician Statements. These forms often don’t leave enough space to list all your symptoms or treatments. They may not ask about side effects of medication. They may not even ask whether your limitations have any effect on your ability to work. Don’t rely on them. Provide supplemental information to your insurance company, including ongoing medical records that show your continued inability to work.When your insurance company requests documents, it can be invasive and time consuming. There are tools you and your lawyer can use to limit the insurance company’s access to your personal information and support your claim for benefits. The attorneys at Bross & Frankel are here to help. We will review each insurance company request for documents and any authorization forms, to make sure you know what you are giving up and defend against unreasonable requests. Contact us or call us today at 856-795-8880 for a complimentary consultation.