Question
Nebraska --
I've been disabled with fibromyalgia (FMS) since 1992 and been receiving disability payments through SSD and also from the insurance company through work. Out of the blue, the insurance company notified me that they will no longer pay because "you do not meet the definition of disability as defined by the contract." The company has simply changed the criteria for diagnosing FMS, saying now that there are no objective findings to show I have a disability. (There never were any objective findings, only subjective!) My health is no better than in 1992, in fact, I have developed additional health problems which aggravate the original ones.
Can an insurance company decide to change their criteria as they wish? My doctor told them I am unable to work - their doctor whom has never met or talked to me says otherwise. What can I do?
Answer
While an insurance company always can argue it made a mistake, or that your health situation has improved, or there are now medications that control the disability, or there are now jobs out there you can fill, and while the company can say it has evidence you are no longer disabled (as if you'd been working or doing substantially the same things working people do on the job) it can not change the policy language under which itis paying the disability benefits retroactively. If under the language of the policy you are disabled, you are disabled.
To suddenly say "we are cutting you off" because of criteria they grabbed out of thin air, suggests the insurance company is acting in bad faith. That is a basis for punitive damages.
There are a number of companies that have cracked down hard in an effort to reduce their outflows. My advice is get the best damn lawyer you can to represent you. And see the stuff on Bad Faith on FreeAdvice.com
Answer
ALawyer --
Thank you for your informative and wise words!
You have given me a good dose of confidence. I was afraid it was a certainty that the company can do whatever it wants, whenever it wants.
I will take your advice and seek out a lawyer.
Jan