Insurance companies employ a variety of different ruses in their attempts to get out of paying off a claim for disability benefits. One of these is the use of allegations of non-compliance with a physician’s prescribed treatment as reason to deny paying benefits.
Insurance companies can legally deny a disability claim for non-compliance. Non-compliance occurs when you fail to follow the insurance company’s rules as laid out in your policy. One of the rules included in every group disability insurance policy is that a policyholder must follow the treatments prescribed by a doctor. This makes sense; when a patient fails to follow the prescribed treatment they run the risk of making their condition worse and extending the period of their disability.
Reasons for Non-Compliance
We recommend that all persons applying for or receiving disability benefits follow the orders of their treating physicians as closely as possible. However, there are circumstances in which an individual might not wish to comply with a physician’s treatment plan for their disability. These can include:
- Fear of serious side effects
- Inability to pay for treatment
- Goes against their religious beliefs
- Mental illness
- Treatment plan conflicts with another treatment plan
In addition to failing to follow a physician’s prescribed treatment, there are other ways in which an insurance company can use allegations of non-compliance to deny a claim.
Policies often use complex and confusing language, making it difficult for a policyholder to fully understand the details of their insurance plan, including the rules for filing a claim or appealing a denial of benefits. Depending on your policy, refusing to submit to an insurance company’s demand for an independent medical exam, seeing your own doctor instead of seeing a specialist, and no longer requiring regular care for your condition can all be grounds for non-compliance.
Protect Yourself from Allegations of Non-Compliance
There are steps a policyholder can take to protect themselves from being denied disability benefits because of non-compliance with a prescribed treatment:
Policyholders have rights. No insurance company or doctor can force an individual to undergo surgery or treatments that are potentially dangerous or have lasting side effects. If this is the case, the claimant should discuss their concerns with their health provider to seek alternative forms of treatment.
Don’t allow treatments to end or gaps in treatments to occur. A claimant must be able to show that they are under the care of a physician or specialist who is appropriately qualified for the condition for which they are claiming disability to avoid allegations of non-compliance regarding appropriate medical care.
Fully read and understand the details of their disability insurance policy and know what is expected.
If they feel the insurance company is not obeying the rules, contact an experienced disability benefits attorney for assistance.
Have You Lost Your Disability Benefits?
Has your claim for disability benefits been denied or terminated because an insurance company decided that you were non-compliant with the rules of your policy? ERISA and other laws give you the right to appeal that decision — but you only have a limited time in which to do so. The first thing you should do is contact the law offices of nationally recognized long-term disability benefits attorney M. Stanley Whitehead.
With decades of experience, M. Stanley Whitehead isn’t going to be confused by an insurance company’s fine print. He’ll be able to fully review both your policy and your medical records to determine if you have actually failed to comply with your doctor’s advice or insurance company requirements.
M. Stanley Whitehead has an impressive record for success when it comes to appealing an insurance company’s decision to deny a policyholder’s claim. He’s helped clients prevail against some of the world’s biggest insurance companies. If your group disability claim has been denied because of non-compliance or some other reason, we urge you to reach out to the offices of M. Stanley Whitehead without delay.