Duties of an Insured (Good Faith)

General Discussion
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Your duties generally when making a claim.

  1. You have a duty to cooperate with reasonable requests from your Insurer. This could be in rehabilitation, return to work planning or Independent evaluations.
  2. You have a duty to disclose. Honest and accurate answers to reasonable questions and updates on your health.The burden is on you to prove that you have the medical proof to support disability.
    You must disclose if you have applied for other benefits or are receiving other benefits.
  3. You have a duty to mitigate. You must be under a Doctors care, be compliant with treatment, medications and be open to trying treatment/surgical options to restore your health.This can include putting your name on cancellation lists for surgery or MRI’s ect…

The issue becomes what is reasonable? You do not have to subordinate your interests over your Insurers. You have a legitimate right to regard your own interests.

You have a right to review the Master policy/ plan documents that set out the provisions of your Company’s policy. Most likely you will have to put in a request to your employer and your Insurer.
You have a right to review your claim file
You have a right to request any forms that may need to be filled out prior to seeing one of their IME doctors or rehab/vocational/Functional providers-you have a right to a copy of any/all medcial reports or files directly from these providers.

You always want to be respectful. If your Insurer is not causing you any issues then no reason to rock any boats and try to stay under the radar,
If your Insurer starts looking at spending money on your claim, asking for more information than usual, wants to refer to rehab or IME-caution ahead. You must always be cooperative-but do not do so blindly. Its business for them, so try not to take their tactics personally.

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This is a very good overview! What is “reasonable” always has to be determined in the situation given the circumstances. If you have questions about what is reasonable I recommend you consult a disability lawyer. In my experience, what a court would consider as “reasonable” is often much more than what the disability claimant considers to be reasonable. That is my experience in doing calls with people across the country.

David Brannen

Disability Lawyer with Resolute Legal

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