One frequent complaint about insurance company claims involves paperwork that is misleading or difficult to understand, leaving the policyholder to figure out how to correctly answer the question while accurately describing the disability. Multiple-choice questions that don’t give a clear picture of a person’s illness or injury can be problematic, especially when the policyholder tries answering truthfully but can’t find an answer that represents his or her condition.
For example, questions asking whether the policyholder is capable of heavy, medium, light or sedentary work might cause a disabled person to answer “sedentary” when in fact the policyholder can’t do any work. But even an answer like “sedentary” indicates the policyholder is capable of some work. That answer is close to the truth, but not actually accurate, through no fault of the policyholder’s.
But because the claimant answered “sedentary” to the question, he or she might have the claim denied. Lawsuits continue to be filed against insurance companies, alleging policyholders wrongly have their claims denied.
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After filing a claim with his insurance companies - MetLife Insurance Company and Guardian Life Insurance Company of America - Weisberg allegedly received a letter stating he was not “Totally Disabled, Residually Disabled, or Presumptively Disabled,” and was therefore not eligible for benefits. Despite providing additional medical information regarding his injuries, Weisberg’s claim was denied. He has since filed a lawsuit against his insurers, alleging breach of contract and bad faith insurance.