Client Services:
Initial Applications for Benefits
As an experienced Consultant I will provide you with all the necessary assistance you need to prepare your initial application disability forms in a manner which clearly communicates the unique circumstances of your medical impairment and why you are no longer able to perform your current material and/or occupational duties. The disability application process is extremely important to the success of your claim and represents the claim representative’s “first look” at the circumstances of your inability to work. The application process is often very difficult for those who are impaired. I’m here to help.
Good Medical Communications
Unfortunately, physicians are in the business of patient care NOT filling out frequent requests for completed forms by insurance companies. It is extremely important for physicians to report accurate medical restrictions and limitations to the insurance company who will use the information available to make decisions as to whether to pay your claim or not. Direct assistance will be given to physicians and physician staff with respect to all communications, written and verbal with any insurance company. Physicians often call DCS, Inc. for assistance as well.
Independent Medical Evaluations (IME)
I will provide you with expert consulting advice, preparation and management should you receive a request to present yourself for an Independent Medical Evaluation. Information will be given concerning what to expect, how to prepare, and how to present yourself for the evaluation on the scheduled date. Learning how to prepare for the IME and remain in control of the process is very important to a successful outcome. DCS, Inc. will provide you with our new strategies for IMEs.
Managing ERISA Claim Denials and DI Appeal Reconsiderations
As a Consultant I will provide you with assistance, knowledge and advice on managing a disability claim termination including whether or not a referral to an attorney in your state is immediately appropriate or not. DCS, Inc. assists insureds manage their own disability claim appeal and will provide direct information on how the appeal process works and direction on working through the appeal process.
Contract/Policy Reviews
It is extremely important for insureds to have an in-depth knowledge of their disability policy or Plan and completely understand what you and the insurance company are entitled to. Disability insurers often attempt to misrepresent policy provisions to their customers in an effort to deny claims with out-of-contract requirements. I will do a policy audit and advise you of your obligations and duties under the policy and those of the insurance company. We want to make sure you receive what you are entitled to under the policy contract.
Objective vs. Subjective Symptoms and Self-Reported Claims
Disability insurers often demand you submit “objective medical evidence” in support of claim even when your policy contract does not require you to do so. In addition, for some impairments there are no objective tests known to medical science that can prove you have what you say you have. It is very important for you and your physician to know precisely what information is required by your insurance company since many claims are denied based solely on the subjective nature of the information you send them in support of claim. As an experienced specialist in managing mental and nervous claims, I will assist you in obtaining the necessary and/or required medical information to support subjective or self-reported claims.
Any Occupation Investigations
As an experienced claims specialist managing ERISA group disability plans, I will be able to assist you in managing the 24-month change in definition in a way that updates current medical restrictions and limitations, accurately computes “gainful”, and provides for a fair assessment of alternative occupations by obtaining Transferrable Skills Analyses which are independent and medically correct. Although disability insurers write these “change of definition” provisions in group policies they really aren’t very good at managing the process fairly. I can definitely advise and help you understand what to anticipate after receiving benefits for 24 months.
Residual Benefits- Working Part-Time
Are you being paid accurately? Or, has your disability insurer arbitrarily decided to pay you only 50% of your scheduled benefit? For some, it may be possible to return to work in a limited capacity over time. It is extremely important to keep track of what you are being paid and whether or not the computations are accurate. I can help you keep a close eye on the accuracy of monthly benefits you receive when you are paid residually.
Surveillance
Surveillance is the great insurance “invasion of privacy” which catches everyone off-guard. Although it is a well-known fact that all disability insurers contract with private investigators who may be asked to observe your activities for several days, DCS, Inc. can provide you with specific methodologies to minimize the value of insurance surveillance. I have several electronic books written on surveillance available to our clients.
Specialty Impairments
Over the years I have developed an expertise in assisting clients with specific medical diagnoses such as fibromyalgia, chronic fatigue, multiple sclerosis, RSD, chronic back pain, Lyme disease, cognitive deficits, and other self-reported claims. Experience managing these impairments is extremely important when gathering medical information from physicians and determining appropriate and regular care.
|
