My question involves insurance law for the state of: California
15+ years ago I purchased Disability Insurance through a group policy a trade organization I belong to has with a major East Coast insurance Company. I purchased a policy for a fixed monthly benefit of $X,000. During the application I was qualified for this level of benefit. I have been paying the premiums for the policy all these years out of personal funds.
I am a self-employed business consultant based in California. 5 years ago I started dealing with depression and anxiety over multiple ongoing family crises. I have been in therapy regularly since then. My illness greatly impacted my ability to work and my income started to drop steadily. The past two years my income has been less than 20% of what it was pre-crisis. I reached a breaking point this fall and could no longer work. My doctors suggested I file an STD claim with my insurance company. The company has been horrible to work with. Ten weeks after contacting them to file a claim they are finally ready to review my claim. They are asking for my 2012 and 2013 complete federal tax returns (including all schedules). Here are my questions:
1. Why do they need the returns if I have been paying for a fixed dollar benefit all these years? Several times over the past decade they mailed me forms asking if I wanted to increase my benefits, which I declined.
2. What is the minimum amount of financial information I need to disclose? In my claim I already told them my incomes for those years. If they must have documentation, would the first two pages of the 1040 be sufficient without all the schedules?
3. The past three years I have been working disabled (as noted in my medical records). If they look at my income, they will see my annual income is a fraction of my covered benefit. Assuming their review of my files and interviews with my doctors lead them to agree with my claim, can they turn around and say I have been over-insured since 2012 and deny most of the benefit I have been paying for all these years? I don't see how they can claim this since they never contacted me for any proof of income before each annual renewal.
4. On a related matter, they have asked my doctors for complete copies of my files. These include very personal discussions about myself and my family which I do not feel is any of their business. This is a simple STD claim - not a criminal case. They have asked my doctors to fill in forms providing very detailed medical information about my condition. Do they have to read all my personal files? I thought these files were doctor-patient privileged and only needed to be divulged in criminal cases.
5. If they do not need to see my files, should I instruct my doctors not to send them? What should I communicate to the insurance company? Can they deny my claim if I refuse to send them the files?
6. If they must have the files, can I ask my doctors to make of copy of the files and redact out personal information like names?
I feel like I am being treated like a criminal and they are doing everything in their power to deny coverage. Any advice would be greatly appreciated.
Thank you!
15+ years ago I purchased Disability Insurance through a group policy a trade organization I belong to has with a major East Coast insurance Company. I purchased a policy for a fixed monthly benefit of $X,000. During the application I was qualified for this level of benefit. I have been paying the premiums for the policy all these years out of personal funds.
I am a self-employed business consultant based in California. 5 years ago I started dealing with depression and anxiety over multiple ongoing family crises. I have been in therapy regularly since then. My illness greatly impacted my ability to work and my income started to drop steadily. The past two years my income has been less than 20% of what it was pre-crisis. I reached a breaking point this fall and could no longer work. My doctors suggested I file an STD claim with my insurance company. The company has been horrible to work with. Ten weeks after contacting them to file a claim they are finally ready to review my claim. They are asking for my 2012 and 2013 complete federal tax returns (including all schedules). Here are my questions:
1. Why do they need the returns if I have been paying for a fixed dollar benefit all these years? Several times over the past decade they mailed me forms asking if I wanted to increase my benefits, which I declined.
2. What is the minimum amount of financial information I need to disclose? In my claim I already told them my incomes for those years. If they must have documentation, would the first two pages of the 1040 be sufficient without all the schedules?
3. The past three years I have been working disabled (as noted in my medical records). If they look at my income, they will see my annual income is a fraction of my covered benefit. Assuming their review of my files and interviews with my doctors lead them to agree with my claim, can they turn around and say I have been over-insured since 2012 and deny most of the benefit I have been paying for all these years? I don't see how they can claim this since they never contacted me for any proof of income before each annual renewal.
4. On a related matter, they have asked my doctors for complete copies of my files. These include very personal discussions about myself and my family which I do not feel is any of their business. This is a simple STD claim - not a criminal case. They have asked my doctors to fill in forms providing very detailed medical information about my condition. Do they have to read all my personal files? I thought these files were doctor-patient privileged and only needed to be divulged in criminal cases.
5. If they do not need to see my files, should I instruct my doctors not to send them? What should I communicate to the insurance company? Can they deny my claim if I refuse to send them the files?
6. If they must have the files, can I ask my doctors to make of copy of the files and redact out personal information like names?
I feel like I am being treated like a criminal and they are doing everything in their power to deny coverage. Any advice would be greatly appreciated.
Thank you!
Disability Insurance: Private Disability Insurance Co. Asking for Private Information Not Relevant to Claim
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