Disability Claims Solutions

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Where do we go from hereThere are now 2185 posts in 184 categories on Lindanee’s Blog. DCS, Inc. has 216 followers for the blog, and 226 for comments. On an average day 1,000 articles are read. I think it’s fair to say that nearly every topic connected with disability claims has now been addressed by me at least once.

In 2019 we observed insurers soliciting third-party reviewers and paper chasers such as Lucens and Genex for SSDI, Release Point for medical records, G4S and The HUB for investigation, with Allsup/Advocator Group hanging on to assistance for SSDI applications. Insurers out sourced more medical reviews in 2019, having hired third-party facilities to provide back-up information used to deny claims.

Never before have disability insurers engaged in high-level covert investigation such as surveillance, particularly The Guardian and The Hartford, at levels considered to be over the top for disability claims. While local private investigators allege G4S and The HUB are “cheap, shoddy” investigators, the job of denying claims for “inconsistency of report” ranks high on the scale of why claims were denied in 2019.

The most frequently denied claim for impairment in 2019 was Migraine Headaches,  with FMS and CFS easily taking second place and Chronic Pain third. In addition, more claims were denied for “lack of medical support” than in any prior year that I can remember. This is consistent with my own conclusions that treating physicians are not taking the time to complete update forms as well as they used to.

Despite the fact that disability insurers “do something on claims everyday to not pay”, in 2019 the majority of claimants/insureds remained unaware of the magnitude of hidden problems taking place internally at the reviewing center. Halfway through 2019, insurers changed the review rules representing a “new normal” for most insureds. Again, unaware of a whole new set of review rules – large numbers of insureds lost their claims because of the lack of specific and adequate medical support.

Another devastating trend I identified in 2019 was the absolute lack of experience and support offered by mental health providers. I was made aware of therapists who had absolutely no experience with supporting claims, did not keep therapy notes and tried to re-create them, openly expressed that they do NOT want to complete paperwork, and furthermore had no knowledge of how to do it. In fact, I found that mental health providers were in fact more “problematic” in 2019 than in prior years.

In short, in 2020 claimants/insureds are likely to become a part of a third-party, highly automated type of disability claim review system that will be even more impersonal and unforgiving than in the past. Every one needs to be on their game and constantly mindful of how the system works, what the Plans/policies allow, and most importantly what constitutes medical “support of claim” and what does not.

DCS, Inc. recommends that in 2020 insureds “take the high road” to success by listening to those who know, (not the indiscriminate Internet), and making an effort to find out information. If you are aware what the insurance company is doing and why, you also should know what to do about it. Doesn’t that make sense?

The key issue for 2020 will be for claimants/insureds to submit medical information that is clear, complete, and timely. I can help you do that. But, the key to claim success in the new year is for you to be smarter and wiser about the claims process, particularly with obtaining medical “proof of claim.”

In 2019 I spoke with many people on the phone about what they needed for medical support to which they spent the next 20 minutes telling me why they either couldn’t or wouldn’t get it. Insureds won’t have that kind of latitude in 2020, and it will be very important to work with claims reps, (be the nice guy), all the while making sure you are providing medical information that cannot be easily disputed or misrepresented. Insureds won’t be best served by what they “think” is true – it will be essential to actually FIND OUT what IS true.

Taking the high road to success with your disability claim will be easier than you think in 2020 as long as you remember the status quo of 2019 went out the door with Old Lang Syne. Same old filled out update forms won’t be adequate, and overly busy Individual Statements and Progress Reports will provide enough information to use against you.

It’s a whole new ball game; if you don’t have the bases loaded, you’re going to lose the game. It’s time to strive for the home runs, and not the strike-outs!

If you have any questions please feel free to contact me. I am ready to accept new clients for 2020 and would love to hear from you.