Long Term Disability Insurance Companies Just Really Suck

I read about Charles Tucker's battle with his disability insurance company in an ABC news article. Charles Tucker, who worked as an accountant, started experiencing fatigue, trembling, numbness in his extremities, and severe headaches. He saw a neurologist who stated that he has multiple sclerosis and is disabled and unable to work. Mind you, this statement as to his diagnosis and prognosis came from a treating physician, someone who had actually seen Tucker, provided treatment to him, and was qualified to rate his functional limitations.

Charles Tucker, not surprisingly, was denied by the long term disability insurance company whose doctor A) had never treated him, B) had never seen him.

If this sounds eerily familiar to how it works with social security disability, that's because there are strong similarities. In the social security disability system, a claimant's records are gathered and evaluated by a disability examiner who reviews them and then, after consulting with a doctor who actually works in the examiner's same processing unit, renders a decision on the claim.

In the SSD system, the social security doctor is arguably the real decision maker because the examiner cannot close the case without a signed statement from his unit's medical consultant (the social security doctor). And this doctor effectively decides whether or not a claimant gets approved or denied for disability without A) ever providing treatment to a claimant and B) ever seeing a claimant. And this might be acceptable for claimants who do not have doctors. However, most claimants do have doctors and the problem is that these doctors are not consulted.

Now what do I mean by that? Well, the records from these doctors are gathered. However, 99 percent of all medical records say almost nothing about a claimant's functional limitations and whether or not they can engage in daily activities (which could include work activity). To actually get an "opinion" from a claimant's doctor, social security would need to send the doctor something known as an RFC form. This is a form on which the doctor can indicate exactly how his patient is limited and to what degree.

Social Security does not do this. Instead, they have their own doctor--who has never seen the claimant once--fill out an RFC form after reading the claimant's medical records. Not surprisingly, social security turns down 70 percent of all disability applications.

So, in a large way, the social security disability process is very similar to the long term disability process. However, I will say that the LTD process is much much worse. Why? Because private long term disability insurance companies have "profit motive". And this fact leads to unethical behavior, as in "taking someone's insurance premiums and then working overtime to make sure they never collect their benefits when they become disabled and unable to work".

I've said it before: Congress needs to regulate long term disability insurance companies to a much higher degree.








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