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Archive for the ‘Best Practices’ Category

One of the things I hear most often from insureds and claimants is that they spoke with insurance representatives on the phone and suddenly they either begin to receive outlandish requests for information or their claims are denied.

Although I’ve been writing and posting for years that it’s not a good idea to speak with insurance reps on the phone, many people still take the risk of doing just that. Insureds are either so scared they think they have to, or sincerely believe if they don’t their claims won’t get paid. Neither one of these are true.

In the interest of trying to explain [again] why it’s not a good idea to speak with insurance reps on the phone, please note the following:

  • Insurance reps are trained to document what you say through “filtered listening” techniques. Anything you say to reps is not documented the way it is said, but is “translated” in adverse ways.  Insurance reps can never “tell a straight story” and aren’t encouraged by management to do so either.
  • If disability insurance were any other kind of business insureds would be falling over themselves to get “it” in writing. All insureds should request to have all communications in writing so that they will have a permanent written record of all of their dealings with the insurance company.
  • Today, insurance reps like to speak to insureds to obtain additional family and social information that can be used by investigators to “hunt down” children and “friends” from Facebook. I’m seeing more and more denial letters containing information from Facebook “friends” about descriptions about outings and other activities.
  • Attitudes of, “I have nothing to hide” often encourages insureds to share more information than is necessary to investigate any disability claim. Not having anything to hide is NOT the point, and it won’t stop insurers from “interpreting information in their own favor.” This is also true of surveillance when insureds are cavalier and say, “I have nothing to hide.” Once you are observed engaging in activity with “nothing to hide” it quickly turns into “work capacity”. Please remember this.
  • Claims handlers can’t harass or abuse you in written letters that become part of the record. If you have a rude claims rep why do you spend the effort to listen to that kind of exchange? You won’t be abused verbally if you insist on everything in writing.
  • Anyone taking opiate or other pain or depression medications should not be speaking to any insurance reps on the phone. In my opinion, those taking certain medications are not able to respond accurately to questions asked simultaneously. At least responding in writing allows insureds to actually “think” about what their responses should be. Claims handlers know “you’re fuzzy” and take advantage.
  • Although my impression is that most insurers are NOT recording conversations, some still do. If you are unaware and say something detrimental to your claim, it can be discoverable in a court of law. Written communications are a matter of record and pretty much say themselves.
  • Claims handlers are given standard templates of information to ask about you, your activities and family. Much of the information is subject to interpretation and can be used against you. How many times have you said to your claims handler, “I never said that”, or, “that’s not what I meant?” What you actually said is never documented.
  • Insurance companies cannot use against you what you do not say.
  • Once something is said to an insurance company, you can’t take it back.

Another way of getting your goose cooked is to have an Internet presence. Recommendations to insureds and claimants – No Facebook, no LinkedIn, no Twitter, no website leftovers – nothing. The whole purpose to Facebook is “socializing” and the worst thing you can do is communicate and share photos and give the insurance company names of your friends, children and family.

Let’s not underestimate the hackers, they can get into any Internet media and use information against you. In fact, many insurers of auto and life insurance also hack social media for underwriting information. Insureds and claimants need to be “off the Net” entirely for the period of time benefits are payable.

Stay away from emails and insurance website portals. Emails are not a good way to communicate. Some insurers do not allow communication by email, others encourage it. The problem with emails is that they may or may not be added to the official record. Insurance website portals have tracking software attached to it that tracks insureds all over the Internet.

Although I’ve been writing articles about communications with insurance companies for many years, not everyone adopts my best practice suggestions and continues to speak with insurers on the phone. I really don’t know how I can more clearly communicate the dangers of verbally communicating with reps who do not accurately report what you say other than provide you with the above information. The above are “best practices” in claims management from the perspective of insureds and claimants.

If you are looking to cook a goose today, please make sure it is not your own disability claim. There are many ways for insurers to use your own words and statements against you. I recommend all communications in writing in order to accumulate a complete written record of all dealings with any insurance company.

Please feel free to give me a call to find out how DCS, Inc. assists insureds and claimants with managing communications with insurers.

 

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As a consultant I’ve always held the opinion there is something inherently wrong with a disability insurer who sends a letter to an insured with inaccurate statements. In fact, some statements are so obviously inaccurate one has to wonder whether those who make them are qualified to review claims at all.

Mass Mutual recently sent an insured a letter stating, “…as a patient you are entitled to these [psychotherapy notes] records.” This statement is grossly inaccurate and I would have thought Mass Mutual would know better.

Very rarely will therapists and psychiatrists release their patient notes directly to mental health patients. It makes good sense not to do so since what is contained in the records could potentially be harmful to those who are reading them. In some cases, therapy notes have been noted to be the cause of patients attempting to hurt themselves and therefore, it is generally recognized that therapy notes should not be released to mental health patients.

In addition, therapy notes are regarded by mental health professionals as proprietary to them written for the purpose of “reminders” of what took place during therapy sessions. Therapy notes are NOT written for the purpose of verifying disability through mental health restrictions and limitations. Mental health providers now regard patient notes as private references for their eyes only.

Over the last several years those who provide mental health therapy have noted the misuse and misrepresentation of information by private disability insurers to the extent that they themselves have office policies not to release therapy notes to anyone. More often providing “actual psychotherapy notes” to companies like Prudential and Mass Mutual hurts insureds more than they help.

Here’s how:

Patient notes rarely document “affect” which is an observation of how the patient’s reactions are, (flat or normal), and therefore insurers use this omission to deny claims. Prudential, for example consistently states in denial letters that the therapist failed to comment on “affect” and denies claims just on that basis.

Most behavioral therapy does not require neuropsychological or other tests to diagnose clinical depression and many other anxiety states. Yet, insurers look for documentation of “objective testing” in the notes when most therapy does not require it, or there is a lack of psychological tests available to diagnose specific conditions. There is a non-acceptance of WHO DAS 2.0 (in lieu of the GAF Score) by insurers, and clearly isn’t considered “objective evidence.”

In other words, if the actual psychotherapy notes do not contain exactly what Prudential and Mass Mutual want to see, claims are denied. The expectation that all therapists document what is needed by insurers to evaluate claims is unreasonable and ultimately unfair.

In the past, Unum denied a depression claim because surveillance showed the insured having sex with his girlfriend in the woods. Patient notes were submitted to Unum but were not considered as compared to the surveillance. Therefore, according to Unum those with depression aren’t supposed to be having sex. What idiocy!

Recently, Mass Mutual threatened an insured with claim termination if he didn’t obtain his therapy notes and submit them. Mass Mutual’s claims manager told me personally, “Those records belong to him and he needs to obtain them and provide to us.”

The letter clearly said, “No additional payments will be made until we receive the daily treatment records from [your doctor]. What if this patient’s therapist refuses to release his patient notes? Should Mass Mutual penalize the insured because his therapist refuses to release notes? And, even if the psychotherapy notes were released, Mass Mutual (Prudential in particular) will allege the notes do not contain sufficient detail to continue to pay the claim.

Are you getting the idea that mental health insureds and patients are “clucked” regardless of what they, or their therapists do?

In any event, Prudential and Mass Mutual continue to insist on psychotherapy notes, which by the way, is an out-of-contract request. No where is anyone’s policy or Plan is there a duty or requirement to submit actual psychotherapy notes as “proof of claim.”

When I asked the Mass Mutual claims manager to fax me the page from someone’s policy requiring submission of actual psychotherapy notes, she gave me the run around and then said, “but our Authorization allows us to request them.” That’s true, Authorizations may request submission of notes, but that doesn’t mean the therapist is willing to release them.

Unfortunately, ERISA Plans often include the phrase, “…satisfactory to us…” which  permits “discretionary authority” to the insurer to decide what is and what is not “proof of claim.”

Mental health claims remain a constant source of controversy as insurers continue to deny claims for failure to submit actual psychotherapy notes they may not be entitled to.

Therapists should be able to submit mental health restrictions and limitations in summary form (filling out forms or submitting letters) rather than giving up patient notes not intended for the validation of private disability.

 

 

 

 

 

 

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As a disability claims consultant I can certainly understand how it could happen that insureds become so angry and frustrated with the claims process that they can’t see anything else except to “make them pay” and “admit everything they’ve done to me.” Although “seeing red” when it comes to managing a disability claim is a common reaction to abuse, anger, rant and non-cooperation doesn’t move claims forward at all.

The fact is, the disability claims process IS frustrating, harassing, and comes at a time when insureds aren’t feeling well and find it difficult to put up with claims handlers who just won’t pay claims. Unfortunately, once insureds really get angry, everything insureds do or say becomes suspect and claims fall into what seems like a bottomless pit of going nowhere.

Some insureds actually act counter to provisions that specify their obligations to meet criteria of Plans or policies. Not too long ago DCS was forced to fire a client because he refused to arrange to go to an IME despite my recommendation that he should go. This particular insured also did not provide the insurance company with the “whole truth” and therefore I could not continue to assist him. The reason? According to this insured, the insurer (Northwestern Mutual) was dishonest and was trying to “trip him up.”

In addition, we’ve come across some claimants who suspect everything, demand repeated proof, and accuse insurers of “lying”, and engage in “letter wars” that also gets them no closer to claim decisions. Most of my readers know I would be the first one to tell you that disability insurers are dishonest and delay or deny payment of claims. At the same time, constantly arguing small “who done it” points is trivial and in general puts insureds on a merry-go-round they can’t easily get off of.

Although insurers should base their investigations and opinions only on the unique facts of claims, there is credibility and “appearance of honesty” suspicions that arise referred to as “red flags”. Constantly contacting claims handlers (remember we do not recommend communicating by phone), and arguing, or engaging in “letter wars” isn’t productive to the claims process and will most likely produce denial decisions.

Therefore, while I validate anger reactions of insureds and claimants to the disability claims process, I certainly do not recommend engaging in constant rants with insurers. Recently, a new client came on board with major issues concerning Guardian. By the time he made a call to DCS he mistrusted everything the company did to date, had not been paid, and was in tears during most of the call.

During our conversation he reiterated that he wanted “proof” of this, and “admission of wrongdoing”, and “statements in writing” etc. It also became apparent during the call that his impairment was due to Bipolar and cardiac issues. One thing was certain – he was so mistrustful of Guardian and had been harassed to the point of desperation by the time he contacted DCS, that his only motivation was to “make them pay for what they did to me.”

“I want every damn thing they owe me”,  he said, “and I want to put them out of business.”

The unfortunate missing part, however, is that this poor insured still had not been paid benefits due to him. Within several days, DCS was able to work with the insured to the point that together we were able to support his claim medically, and he received a $40,000 check in the mail. I could not get him to stop crying.

In this case I think Guardian brought most of the anger and suspicion upon itself by demanding a field interview with both the claims handler and a field investigator (Guardian calls them “Technical Consultants?’) showing up to ask questions of someone diagnosed with Bipolar Disorder. Of course, this interview wasn’t going to go well and it didn’t. This is an example of what I mean when I say, “disability insurers know very little about disability.”

Also, well-intentioned, but inaccurate information provided by friends and neighbors can also incite one to wrath and isn’t always helpful either. Insureds who file disability claims need accurate information about the claims process, not opinions from those who really aren’t “in the know.”

Instead of acting upon anger, overreaction and suspicion, insureds and claimants should be more focused on “solving the problem” which in most cases is “paying the claim.” Insureds who find it difficult to calm down and act accordingly could benefit from having a consultant sort through what’s needed and getting the job done.

In any event, ranting and arguing with insurers doesn’t result in timely payable claims. Again, although I validate the feelings of anger and frustration with an impossible claims review process, I do not recommend constant suspicion on the part of insureds that makes them appear uncooperative, out of control and vindictive.

Ranting and arguing with an insurance company causes those who are reviewing claims to conclude, “the insured is crazy”, and creates “red flags” that lead to the lion’s share of investigation. While Unum might just laugh and go on investigating, Guardian is more apt to investigate more intensely and be suspicious of everything that happens moving forward.

Perhaps you may not have thought of this situation in these terms, but there are only two decisions insurers can make as a result of filing a claim – pay the claim, or deny it.

A successful outcome is when an insurance company pays benefits under the terms of the policy. Arguing and ranting and trying to get the reps fired isn’t going to give you the claim result you are looking for.

 

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Last week I received several phone calls from insureds who said they are using Lindanee’s Blog to manage their claims. Lindanee’s Blog was originally created in order to provide accurate information concerning private disability since much of what is found on the Internet is basically misinformation.

While I’ve tried to provide readers with basic “good claims practices”, Lindanee’s Blog is not intended to be a workbook for everyone on how to manage disability claims. Each claim is a unique situation, and the truth is, my Blog represents approximately 10% of the information required in order to manage any disability claim.

I’m also concerned that it appears many insureds are actually “researching” information on the Internet and are accepting the case stories they find as gospel applications to their own claims. Most of what is found on the Internet is told from the worst possible scenarios. So, please allow me put this into perspective.

If disability insurers denied as many claims as the Internet suggests, they wouldn’t be in business. Based on my 25 years of experience and my own consulting practice it appears to me that insurers pay between 40-50% of claims. Of course, Agents won’t tell you that when they sell you your policy, but overall I believe the number is correct.

Most insureds probably aren’t aware that private insurers underwrite their policies and charge premium on a liability acceptance rate of 60%. Therefore, coming out the gate, insurers only plan to pay 60% of claims at the time they sell their policies. In my opinion, ERISA business only pays up to 50% of claims due to the targeting of vulnerable claims, and also due to the 24-month change in occupation and 24 month limitations for mental and nervous claims.

Given all factors considered one could say, that any insured or claimant has a 50/50 chance of having a disability claim paid to maximum duration. Of course, it should go without saying that transference of any information found on the Net to your own claim is not a good thing, and I include Lindanee’s Blog in that analysis.

The articles posted on Lindanee’s Blog are written to a generalized audience for the purpose of providing information about private disability insurance at least equal to that of the  insurance company having discretion to pay or not pay claims. It is not intended to be an instruction book on how to manage claims because the information is not “all there is to know” about disability claims.

In a way, there is no way I could post enough articles to give readers the benefit of my 25 years experience — it’s just not possible. In addition, I wouldn’t remain in business very long if I gave out all of my proprietary information to the public via a Blog.

It’s pretty scary to me to realize that we’ve gone from sarcastically saying, “Oh, it’s in the newspaper so it must be true” to “it’s on the Internet and it IS true.” Just go the YouTube to see that most of what’s there isn’t true at all.

Although all of the information here is accurate and is very helpful, it isn’t the whole story and insureds should make note of that. I hear a great deal of feedback from claimants who tell me, “Linda you nailed it! This is exactly what my insurer is doing to me”, and although that may be true for many people, it clearly isn’t true for everyone.

I’m proud to be of help to insureds and claimants and I’m glad the information published on Lindanee’s Blog is useful to those with private disability claims. However, every claim is different, and not every piece of information is applicable to every claim.

I also hear a great deal from insureds, “I have a friend of a friend of a friend who told me”, or “I have a close relative who is a lawyer who told me…but he doesn’t specialize in insurance law”, or “Someone I worked with who had a disability claim told me…” Albeit good intentions aside, insureds must realize that such information is coming from those who are not qualified to render opinions.

Thank you to all those who continue to support Lindanee’s Blog, I hope the information here is helpful to you, but it is not intended to be an instruction book on how to manage disability claims.

Every claim is unique, with differing sets of circumstances and requires responses and actions that relate to the claims directly. What seems appropriate for one claim, may not be for all others.

Please let me know if you have any questions in addition to what’s here on the Blog.

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dont-poke-the-bearOne of the things insureds and claimants often get themselves involved in is “ranting, raving and arguing” with insurance companies and their representatives.

Due to the fact that the disability claims process is complex and frustrating, some insureds become so angry they feel the need to debate every insurer issue/request to a fault. Letters go back and forth from claims rep to insurer, but no issue is ultimately resolved. Insureds suddenly find themselves on an eternal merry-go-round using repetitive arguments in an attempt to resolve infinite circular issues. It doesn’t work, and is a major waste of time!

Attorneys also find themselves riding the merry-go-round balancing “getting information into the record” without creating new red flags insurers had not thought of yet. Not every claims issue is a “legal matter”.

In fact, most claims issues are administrative in nature until an unwise attorney pushes his weight around and turns a very simple request into the potential for the “Scopes trial of the century.”  [State of Tennessee v. John Thomas Scopes] In my opinion, attorneys also have a conflict of interest between acting in the best interests of the client versus how to get the most money out of the case.” From a claims management perspective attorneys often create more red flags than they resolve, pushing cases into litigation for no reason.

What worries me is that the “rant, rant, rant” methodology of defending disability claims often opens doors to insurance red flag issues insurers never would have thought of if insureds had not mentioned it first. Insureds and claimants ALWAYS over speak their claims when trying to convince insurers claims are legitimate. Clearly, choosing to argue over every normal and customary request “pokes the hibernating bear” and puts YOUR claim at the top of the denial list.

Every written communication to disability insurers should be wrapped around issues involving contract provisions. Insureds would do well to remember that the only relationship that exists between insured/insurers is written in the policy contract or Plan. Citing policy and Plan provisions in defense of a disability claim is impossible to do when insureds and claimants haven’t obtained or read a copy of the document.

If an argument isn’t specifically identified in the Plan or policy document it is most often an insurance internal administrative pattern of practice that insurers attempt to enforce as if it were a contractual matter. Most ERISA Plan documents contain language that requires claimants to submit “other information” such as responses to questionnaires, Claimant and Physician Statements – not worth arguing about. I regard these requests as “normal and customary” and claimants should cooperate by “responding in like kind”, meaning answering only what is asked, or providing only what is requested.

Ranting, and arguing without citing contractual support or provisional language is punting in the wind. Normal contractual requests for information should be “reasonable” and “contractually supported” whether the insurance company raises the issue, or the insured.

Advanced degrees, professional stature, medical or legal training does not suddenly make anyone an expert in disability claims management. I generally tell callers, “Disability claim denials are an equal opportunity occurrence” and higher education does NOT an expert make.

In my opinion, insureds who presume higher knowledge about claims due to higher educational status often open the door to a “lion’s share of investigation” because they present themselves to insurers as “educated”, but manage their claims in opposition to their own best interests. I can’t tell you how many times I’ve received calls from highly educated insureds who have misinterpreted policy provisions and have already attempted to defend invalid arguments with insurers.

The point is, do you really want to poke that bear? Insureds and claimants always have the right to defend their policy/Plan/claim and submit information to the record or Administrative file. But, there is a right way to defend policy issues without ranting, raving, and causing red flags in the review process that never seem to go away.

Attorneys who also manage claims should not presume to invoke “legal arguments” for normal and customary update requests. There is really no need to do that.

Insureds and claimants often have much more successful claim outcomes by leaving the hibernating bear alone and only responding to specific questions asked or raised. And then, responses should always include citations of policy provisions that support your point of view or defense of your claim.

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It is way too lateLast week, DCS received several inquiries concerning my services to assist with appeals. As many of your know, last year (prompted by Unum’s special interests), the Maine Attorney General ruled that consultants should not be assisting with appeals because to do so is practicing law.

Although in the past, I assisted insureds and claimants with many successful appeals, I was not all that disappointed in the ruling and agreed with it. Unfortunately, we live in a very different insurance environment where companies such as Unum not only refuse to overturn unfair denial decisions but often agree to “settle” on the courthouse steps. Many insurers now “push” insureds into litigation in hopes they will be driven to bankruptcy by attorney fees.

However, a common sense argument can be made that the real value of a consultant is in the proactive, pre-emptive and preventative nature of services offered to the public. After all, the primary goal of any insured or claimant should be to continue to receive benefits as long as they continue to meet the definition of disability as written in their policies or Plans. No claimant should be forced to give up 45% of future benefits to age 65 in order to receive less than 30% of pre-disability earnings just to receive a benefit a all.

Insureds and claimants who are the most successful recognize the value of staying in front of the claims process, not scraping the bottom of the pit chasing what’s left behind after a claim is denied. It is in this area that attorneys fall short of expertise since they are, as a group, not great disability case managers. While attorneys do have a role in the litigation of disability claims, they are also part of the problem when they expect to walk off with most of the benefit after-the-fact.

Disability Claims Solutions, Inc. assists insureds and claimants with the all-important busy work of successfully managing disability claims. I advise insureds regarding their policy or Plan provisions and provide insureds with realistic perspectives regarding the claims process. It is important for disability consultants to have proven actual claims experience since that can make all the difference in simplifying procedures and resolving problems.

Although there are never any guarantees when it comes to disability claims, the best chance of success is in the proper management, documentation, and pre-emptive actions taken by insureds and claimants to abide by their contractual duties and responsibilities while at the same time holding insurers accountable for the proper adjudication of policy and Plan provisions.

Therefore in my opinion, claim denials should rarely happen to legitimate, well-documented disability claims. Contacting DCS AFTER a claim denial is too late for report, claim documentation, or any other pre-emptive measure that could have been taken to provide insurers with the best possible proof of disability.

Attempting to engage in lengthy, costly and sometimes ineffective management of a claim denial and subsequent appeal is not the best objective for insureds and claimants to look forward to.

Unfortunately this week, I’ve had to inform several claimants that it’s too late for me to help. Please take some time to reconsider your overall objectives for your claim, and make decisions as to the most valuable resources available to meet those objectives.

Most insureds and claimants just want their benefits to be paid. The services I provide are pre-emptive, not reactive to a bad outcome.

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Best Practices For 2016

Best Practices2As we move closer to the new year it’s important to re-examine insurance claim “Best Practices” and begin anew with better knowledge about private insurance and how the system works.

So much of the information on the Internet (including this blog sometimes) is negative. If anything else, this post should serve as a reminder that there ARE disability claims that are paid, and the process can work if managed well.

INSURANCE CLAIM BEST PRACTICES

  • Obtain copies of all disability insurance policies at the time of coverage or enrollment. Keep them in your possession for easy reference in the future.
  • Read and understand very clearly what duties you have as the insured/claimant, and what obligations the insurer has to review your claims in good faith and fair dealing.
  • Understand the limitations of your policy or Plan and develop other family strategies to fill in financial gaps should claims be unexpectedly denied. This should be done prior to filing for disability.
  • Be prepared to defend your rights under the terms of your policy or Plan in accordance with the provisions contained therein. Read your policy. You can’t defend what you don’t know.
  • Study the policy or Plan in detail to determine how much benefit you are entitled to, minus any reductions for other monthly income such as primary and family SSDI. If there is not enough benefit to support you and your family, have a Plan B to financially supplement your policy or Plan. Do not wait until you become disabled to do this.
  • Understand what your rights are concerning FMLA (Family Medical Leave Act) and understand at what point your particular employer will terminate your employment, health and other benefits.
  • Insist on communicating with insurers only in writing so that you can accumulate a written record of all of your dealings with the insurance company. Neither policies nor Plans require you to engage in verbal communication with insurers, and insureds should be given the opportunity to generate their own complete written record, the same way the insurance company will. Insurers can’t hold against you what you do not say.
  • Be honest and forthright in all of your dealings with any insurance company and communicate what’s true and accurate. This is particularly important in reporting earnings.
  • Keep in mind that “less is more” when completing insurance questionnaires, update forms, and other insurance inquiries. You do not need to “fill up the form”. Again, “Yes” and “No” remain very good answers to most questions.
  • Answer all questions raised by your insurer honestly and truthfully, but only answer specifically what you are asked. Do not elaborate, volunteer additional information, or over speak your claim about your family.
  • Do not attempt to defend your claim by writing lengthy letters to claims representatives explaining your disability. These letters can be viewed as “work capacity” by the insurance company.
  • Have frequent conversations with all treating physicians so that it is decided in advance how phone calls from insurance doctors will be handled. Tell your doctor you are respectful of his/her time and will pay reasonably for any additional paperwork required.
  • Inform your physician that he should invoice for his time and that of his staff when insurer requests are sent directly to his office. Physicians can invoice insurers for staff time, his/her hourly fee, photocopying, overhead, use of administrative resources etc. Encourage physicians to invoice insurers when requests are sent directly to their offices.
  • Contact your claims rep (in writing, of course) and let him/her know anytime you are unable to meet update deadlines. Insurers are pretty reasonable in allowing more time when they are communicated with.
  • Ask your doctor to let you know when requests for patient notes and completed forms are received from the insurance company and insist that you review all completed forms before they are faxed to insurers.
  • Avoid any circular conflicts or arguments with claims reps even in writing. Always remain the professional who cites policy provisions as back-up in your letters.
  • Do not rant or argue with any insurance company. It generally makes you look bad.
  • All disability insurance companies are permitted to fully investigate claims. This includes IMEs, surveillance, private investigation, obtaining medical records etc. Do not argue and rant about things you cannot change, or are not under your control. It is perfectly normal for any insurance company to fully “investigate” your claim and continue to engage in any “risk management activity” they determine is appropriate. Learn to deal with it.
  • Do not take your insurer’s actions personally. Insurance companies look to reduce financial reserves to increase profitability and rarely make decisions considered to be in “your best interests.”
  • Seek help from experts when dealing with Independent Medical Evaluation requests or field visits.
  • Do not sign more than one valid Authorization at a time. You won’t be able to keep track of how many are out there.
  • If you do not want to repay an SSDI overpayment to your insurer, opt to allow an estimate to be taken from your benefit on the Payment Option Form. If you choose unreduced benefits while waiting for SSDI approval, then plan to pay back any retroactive lump-sum received from SSDI. A deal is a deal.
  • Do not exceed medical restrictions and limitations reported to any insurance company, not because you have a disability claim, but because it is the best thing to do for your own health and safety.
  • Report all earnings to insurers when received.
  • Do not engage in Internet social media such as Facebook, Twitter, MySpace or LinkedIn. Insurance companies have Net “snoop dogs” who wander the Internet looking for information about you. Do not use insurance company website portals that may contain tracking cookies.
  • If you cannot physically or mentally cope with the complex paperwork or continuous issues raised by insurers – get expert help from someone who is in the know. It is far better to avoid denials then taking on attorney fees and lengthy lawsuits.
  • Do not attempt to appeal a denial decision on your own. Try to retain the services of an experienced ERISA, or bad faith attorney, and not those who advertise on YouTube, or who have national, but indifferent representation.
  • Do not accept a settlement offer out of fear, financial need, or desires to “get out from under” an egregious insurer. Settlements are life decisions and should be treated accordingly.

I’m sure there are other “Best Practices” out there, but these should point you in the right direction for 2016. In the end, according to figures from my practice, insurers wind up paying 40%-50% of LTD claims long-term (after any occupation investigations).

Although this post isn’t about selling DCS’ services to you, we ARE an option if you find it difficult to manage your disability claim well.

 

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