02/23/2026
Common Tactics Used by Insurance Companies to Misrepresent Physician Statements
First, often insurance long-term disability providers engage in
practices that are opaque, dismissive, and sometimes misleading.
They do this by providing forms for treating medical providers that inadequately document a patient’s restrictions and limitations. For instance, they often do not allow medical providers to describe restrictions and limitations that preclude full-time competitive employment.
For example, waxing and waning symptoms can create a medical record in which it is noted that at times patients function well and at other times are completely dysfunctional.
Also, insurance companies disregard a patient’s baseline and hereby interpret phrases such as “doing well,” “shows improvement,” etc. as indicative of functional health and the capacity to work.
Because insurance companies do not go out of their way to solicit complete information that would compel them to grant benefits, they often do not ask information about a disability’s effect upon absences, punctuality, workplace errors and productivity. Instead, their forms are often inadequate, vague, and incomplete.
These forms deceive both patients and their physicians into believing that a full picture of a patient’s actual disability is being provided to the insurance company and considered by it.
Second, insurance companies often use language, terms, and phrases that are poorly understood by medical providers. Those terms include “constantly,” “frequently,” and “occasionally.”
Occasionally can mean as little as a few times during the day to up
to one third of the day. That is often not explained. Insurance companies are inexact in distinguishing the differences between full-time competitive work vs. part-time or subsidized work.
They do this by eliciting responses from treating physicians in which the treating physician may be thinking that they are indicating that their patient can do some work but are not suggesting they can work full time in a competitive employment
setting.
Within that ambiguity, insurance companies often conclude, based upon the treating physician’s input that a patient can work in full-time competitive employment when that opinion was not intended by the physician. They also fail to indicate that competitive work often requires reliability that precludes absences.
Medical providers, who may work in industries that allow significant accommodations for illnesses and other absences, may not be aware that most industries in the United States do not tolerate absences of two or more per month and sometimes even 1.5 absences per month–especially during initial-hire probationary periods that a lot of disabled persons cannot complete.
Third, insurance companies often improperly and misleadingly suggest that the term “objective evidence” excludes that evidence that can be derived from a patient’s signs and symptoms that the medical provider observes during examinations.
They also at times misleadingly suggest that once a medical condition is established through “objective evidence” that subjective symptoms cannot be considered or that a physician cannot consider their own extensive experience when opining upon a patient’s limitations and restrictions.
Lastly, insurance companies often do not seek clarification when a written or an oral question is asked of a medical provider and the question is vague and/or the response given is ambiguous.
In such situations they will usually infer a meaning that is most supportive of their denial of benefits.
In short, it is the insurance company’s nature to look for any and all ways to deny coverage and preserve profits instead of going out of its way to evaluate a claim in a transparent, equitable and fair manner.