The broad question is what are the things you have to watch out for when you’re filing a claim and what should you do? Do insurance companies conduct surveillance? Yes. Do they run around with cameras trying to see if you can carry groceries from the grocery store to the car? If you can carry groceries you can do orthopedic surgery. Yes, they do that. Do they have someone follow you all over the place to show how much you’re driving a car especially if you said that you were impaired in driving an automobile? Yes, they do that. Is it a good idea then to handle your own disability claim? No, not really. The maxim that applies to lawyers, a lawyer should never represent him/herself on a case, applies to everyone else as well. It’s always better to have someone advocate for you on your behalf, especially while you are not at your best as you’re facing a disability and an extreme shift in your professional and personal lives as a result of your changed circumstances.
A classic scenario goes like this. The insurance company sues you first, in a county that they perceive is favorable to companies instead of individuals, a location not convenient to you, before you file your claim. They’ll sue you in what’s called a declaratory relief action for the court to declare the rights of the parties under the contract. Let’s say that they anticipate that there’s going to be an issue about partial versus total disability. Why would the insurance company sue their policy over it? Insurance companies will give you a list of your substantial material duties in your chosen profession and we all know, that will be a long list as every job entails all manner of responsibilities and actions, great and small. The insurance company will then say, that you can still perform some or many of the items on that list and therefore you’re not totally disabled.
I’ve written extensively about the long-term partial disability insurance trap and how to avoid them.