Disability Claims Solutions


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Don't Be LateUnfortunately,  some claimants are getting a bit lax when it comes to updating paperwork and obtaining APS statements signed by treating physicians.

Although in the past, insurers have been OK with reasonable extensions, that is no longer the case. Those who have been on claim for a long time may not be aware that the environment of disability insurance is not what it used to be. While internal claims management by insurers was never fair, or very good, today the process of review is much more demanding and unforgiving.

I realize as a consultant claims manager that treating physicians do not work within timelines given by insurers. But, what I’m referring to specifically are insureds who do not fill out the paperwork right away and think that “Unum (or any other insurer) can wait until their next scheduled appointment. Those days are over.

I also was made aware of the fact that some claimants do not check their mailboxes (real mailboxes, not electronic) on a regular basis. Or, they go on vacations and have no way of knowing what was received in the mail. Worse yet, a few claimants just deal with the paperwork when they want to deal with the paperwork – not a good habit to get into.

While I understand the probability of “not feeling well enough to complete disability paperwork”, insurance companies have no such understanding or sympathy for delay based on how one feels at any given point in time. Remember, the claims process is not humanized and works more like widgets slowly going along on an assembly line.

Finally, there are insureds who actually “fall out of regular care” and have no treating physician to speak of to sign paperwork. This situation could wind up with a claim denial since most Plans require claimants to remain in regular and appropriate care.

What is happening is that insureds are sending in paperwork just before, or on the date due. It takes 2-3 days for the data centers to upload the paperwork and get it to the claims handlers. By that time another letter has already gone out telling you the paperwork is late.

Insureds should not expect any insurance company to do what’s right, only what’s in their own best financial interests. Therefore, DCS’ recommendations have changed with the changing times. I now recommend that all paperwork should be completed right away.

In the past, I’ve always recommended that patient notes should be obtained shortly after every office visit, so that when updates are received claimants are already prepared to send them in with the forms.

Although this article doesn’t address the issue of insureds being given unrealistic “short deadlines” by insurers (I’ve written about this in the past), it is important to enforce Plans and policies when it comes to stated deadlines.

There is nothing wrong with claimants calling “a thing, a thing” particularly when a Plan says you have 45 days to submit proof of claim and you’ve only been given 10 days to respond.

Defend what’s true, and then meet the appropriate deadline. Insurers are no longer supporting deadline extensions they way they have in the past.