When you’re facing the challenges of a long term disability, your disability insurance policy is meant to provide the financial support you need during your time of need. However, the claims process can often be complex and overwhelming. If your insurance company requests an interview as part of their assessment of your disability claim, it’s crucial to understand your rights, obligations, and how to navigate this critical step.
In this article, we’ll guide you through the important considerations and steps to take when your insurance company asks for an interview, strategies to protect your interests, and how a long term disability attorney at The Maddox Firm can help secure the disability benefits you deserve.
Why Does My Disability Insurance Company Want an Interview?
Disability insurance companies conduct interviews and examinations as part of their claims investigation process. In theory, these interviews aim to gather information about your medical condition, the impact of your disability on your daily life, and your ability to work. While not always the case, an interview request can be a red flag that your insurance company is looking to deny or terminate your claim for benefits.
Here are a few reasons your insurance company may be requesting an interview:
Your evidence alone is not enough to approve your claim. The interview request may indicate that your insurance company may believe they lack sufficient information to make a decision on your claim. An interview is a way for them to gather additional details that could be used to support a denial decision.
Your insurance company is skeptical of your condition. When your insurance company requests an interview, it often indicates that they are looking closely at your disability claim. They may be searching for inconsistencies, discrepancies, or any reason to challenge the validity of your claim. They may compare your interview responses to your medical records, prior statements, and other evidence. If they identify inconsistencies or contradictions, they could use this as a basis for denying your claim.
Your claim is high-value and/or complex. In cases where your claim involves substantial benefits and/or complex medical conditions, insurers may be more cautious and may use interviews to scrutinize your claim more thoroughly. Examples of “complex” claims are those that involve multiple medical conditions, subjective symptoms, complicated income structures, multiple insurance policies, and/or pre-existing conditions.
It’s important to approach an interview with your insurance company with vigilance, especially if you have concerns about your insurance company’s actions or if they have a history of denying claims unfairly. Consulting with an attorney experienced in disability insurance claims can help you navigate this process, protect your rights, and present your case effectively during the interview.
Can I Refuse an Interview with My Insurance Company?
Most disability insurance policies include clauses that require policyholders to cooperate with the insurance company during the claims process. This cooperation typically involves providing information, medical records, and participating in interviews or medical examinations as requested. Refusing to attend an interview may be considered a violation of this cooperation clause and have negative consequences for your claim.
While outright refusing the interview can put your claim at risk, there are a few steps you can take to protect yourself:
Do not host an interview at your home. Hosting an interview with the field representative at your home is generally not recommended, and it’s always preferred to have the interview conducted in a more neutral and controlled environment. The field representative conducting the interview at home may draw conclusions from your environment, such as the cleanliness, organization, or accessibility of your home. These observations may be misinterpreted or used to assess your disability unfairly. If the interview must take place in-person, request a neutral setting, such as your attorney’s office.
Consider requesting the interview be done by phone. If requested, your insurance company may agree to conduct the interview over the phone rather than in-person. Whether this option is preferable will depend on a few factors, most importantly the nature of your disability. If you experience visible symptoms and limitations (such as tremors, skin conditions, the use of mobility aids and medical devices, etc.), it may be to your benefit for the field representative to see you face-to-face. However, many disabilities are “invisible illnesses,” meaning the symptoms are not visible and easily demonstrable. Some examples of these symptoms include pain, fatigue, headaches, nausea, and cognitive impairment. Your field representative may not “see” your disability and walk away from the interview believing you do not display a significant lack of functioning. Of course, the field representative is not a medical doctor and cannot determine your condition from an interview alone—still, this impression may bias how they evaluate your claim.
Request the interview questions beforehand. Your insurance company is generally not obligated to provide you with their questions ahead of time, but it never hurts to make this request. Sometimes your representative will provide the questions in full if asked. Alternatively, they may not provide the exact list of questions, but will disclose the nature of the questions (whether they will be asking about your symptoms, your expected recovery timeline, your income, etc.). Any information you can glean about the subject of the interview beforehand can be valuable for preparation.
What Will My Insurance Company Ask Me?
The questions your insurance company will ask during an interview related to your disability claim can vary depending on the specific circumstances and the purpose of the interview. However, your insurance company will generally seek to gather information that helps them assess the validity of your claim and the extent of your disability.
Here are common types of questions you can expect:
General personal information: Name, address, phone number, and other contact details;
Employment and Occupation: Details about your current and previous employment, including job titles, responsibilities, and work history, the dates of employment with your last employer;
Medical Information: Information about your medical condition, including your diagnosis, treatment, and prognosis, details about your treating physicians and healthcare providers, medications you are currently taking and any side effects, and any hospitalizations, surgeries, and medical procedures related to your condition;
Daily Activities: Questions about how your symptoms impact your ability to perform daily routines and activities (such as getting dressed, cooking, cleaning, and personal care), whether you can drive, shop for groceries, or perform household chores, any hobbies or activities you engage in and how your disability affects them, and any assistance you require for these activities;
Work-Related Questions: How your disability prevents you from performing the essential duties of your occupation or a similar occupation, your understanding of the occupational requirements and responsibilities of your job, and any vocational training or education that might impact your ability to work;
Financial Information: Questions about your income, including your pre-disability earnings, information about other sources of income, and whether you have other disability insurance policies in place;
Treatment and Medical Providers: Details about the medical professionals you have consulted or received treatment from, the frequency of doctor visits, any ongoing medical treatments or therapies, and any future medical appointments or scheduled treatments;
Changes in Your Condition: Whether your condition has improved or worsened since your initial claim and any changes in your medical treatment or medications.
Assistive Devices and Modifications: Information about any assistive devices or modifications you use to help with daily activities or mobility;
Social and Recreational Activities: Questions about your social interactions and participation in recreational activities, including any limitations you face;
Other Benefits and Claims: Whether you have applied for or are receiving disability benefits from other sources, such as Social Security Disability Insurance (“SSDI”), and any pending claims or legal actions related to your disability.
How Do I Prepare for the Interview?
Preparing for an interview with your disability insurance company is essential in order to present your case accurately and effectively. Here are some ways you can prepare for the interview:
Understand the Purpose: Contact your insurance company to clarify the purpose and scope of the interview. Is it a routine update, a review of your medical condition, or something else? Understanding the purpose will help you prepare specific information.
Review Your Policy: Carefully read and review your disability insurance policy. Understand the definitions of disability, the terms and conditions, any exclusions, and the benefits you are entitled to receive. Knowing your policy inside and out will help you answer questions accurately and in line with your coverage.
Gather Documentation: Collect all relevant documents related to your disability claim, such as medical records, doctor reports, test results, and any correspondence with the insurance company. Ensure that your documentation is complete and organized for easy reference during the interview.
Prepare a Timeline: Create a chronological timeline of your disability, including when it began, the medical treatments you’ve received, and how your condition has evolved over time. Be ready to discuss the progression of your disability during the interview.
Practice Interview Questions: Anticipate the types of questions the insurer may ask during the interview. Common questions might include details about your daily activities, medical treatments, medications, and how your disability affects your ability to work. Practice your responses to ensure clarity, consistency, and accuracy.
Be Truthful and Consistent: Honesty is crucial during the interview. Provide truthful and consistent information about your disability and how it impacts your life. Avoid exaggerating or minimizing your condition.
Stay Calm and Composed: During the interview, remain calm and composed. Speak clearly and concisely, sticking to the facts and avoiding emotional language. Stay focused on answering the questions asked.
Don't Joke or Use Sarcasm: Your interviewer may not be the person making a decision regarding your claim. Instead, the decisionmaker may be reading a transcript of the interview. Your joke or sarcasm may be taken seriously in written format. The decisionmaker could really believe you can run a marathon!
Don’t Be Too Hostile or Too Friendly: Many of our clients are understandably frustrated and upset when their insurance company requests an interview. It can often feel like a roadblock to desperately needed benefits and an attack on their character. However, expressing hostility, raising your voice, or snapping at the representative will not do your claim any favors. Remember that the interviewer wants to make sure that claimants who deserve disability benefits actually get them. On the flip side, keep in mind that the representative is not your friend. Keep your answers polite, straightforward, and clear. Be aware that any jokes or sarcasm can be interpreted wrongly. Do not offer additional information unrelated to your claim that your insurance company hasn’t asked for.
Document the Interview: Take notes during the interview to document what was discussed. Note the questions asked and your responses. This can be helpful for reference and in case of any disputes later.
Ask for Clarification: If you don’t understand a question or need clarification, don’t hesitate to ask the representative for more information or to rephrase the question. It’s essential to ensure that your responses are accurate.
Consult with an Attorney: If you haven’t already, consider seeking legal advice from an attorney experienced in disability insurance claims. They can provide guidance on how to handle the interview, help you prepare effectively, and attend the interview to ensure your insurance company does not overstep.
Remember that your disability insurance company will likely use the interview to gather information that can impact your claim, so it’s crucial to be well-prepared, truthful, and organized during the interview. A long term disability lawyer can be valuable in ensuring that your rights are protected throughout the process.
How Can The Maddox Firm Help Me With My Insurance Company Interview?
The Maddox Firm has helped hundreds of clients navigate the short and/or long term disability claims process to successfully secure their benefits. Our experienced team can provide valuable assistance and support when dealing with your insurance company interview.
Here’s how a long term disability attorney at The Maddox Firm can help:
Policy Examination: A long term disability attorney at The Maddox Firm will review your disability insurance policy thoroughly to understand the specific terms, definitions, and provisions that apply to your claim. We can explain your rights and obligations under your disability insurance policy, ensuring that you understand what you are required to do during the claims process, including cooperating with interviews and examinations. A careful review of your policy enables us to provide you with precise guidance on how to handle the interview with your field representative.
Interview Preparation: The Maddox Firm can help you prepare for the interview by explaining the types of questions you can expect, suggesting appropriate responses, and ensuring that you present your case accurately and consistently.
Advocating for Your Interests: The Maddox Firm will request additional information about the purpose of the interview and the questions your representative intends to ask before it occurs. During the interview, The Maddox Firm can be present to make sure you don’t inadvertently provide information that could harm your claim. Our attendance helps ensure that your insurance company follows the law and treats you fairly.
Documenting the Interview: The Maddox Firm will document the interview in detail, including the questions asked and your responses. This can be useful in case of disputes or if there are inconsistencies in your insurance company’s handling of your claim.
Appeals and Litigation: If your claim is denied or terminated, The Maddox Firm can assist with the appeals process, including gathering additional evidence, preparing a strong case, and, if necessary, filing a lawsuit against your insurance company to fight for your benefits.
Peace of Mind: Having a long term disability lawyer by your side can provide peace of mind during a potentially stressful process. You can rely on their expertise to navigate complex legal and insurance matters.
The Maddox Firm can provide guidance from the outset to help you understand your rights, obligations, and how best to protect your interests in the event of an interview with your insurance company. Our knowledgeable team will look over your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your short and/or long term disability claim.
Speak with a long term disability attorney to help you file your claim, appeal, or litigation the right way.