Lately it has come to my attention just how many people are using the content of Lindanee’s Blog to manage their claims. I’ve come to know this because eventually many of the same insureds find it necessary to call me and ask for help.
Although I have said in the past, many times in fact, that I only publish approximately 10% of what anyone would need to know to manage their own claim, I want to make it clear that I’m hearing about errors made by insureds either because they used the Internet in an inappropriate way, listened to a “buddy” or family friend, or assumed they knew what to do, but made terrible mistakes.
I acknowledge that there are also many insureds who are managing their own claims quite successfully, and they do a great job! Many times I hear from insureds who have success stories to tell, and I’m very happy to hear that claims remain paid, not denied. But those insureds represent only a small percentage of the total number of claims and unfortunately, there are more people managing claims blind that not.
There are more people in the United States who DO NOT know how to manage disability claims than there are those who do. In addition, there is an entire group of insureds who “think” they know, but haven’t a clue. Unfortunately, the bad thing about trying to manage a claim from the outfield is that information winds up in the file and in most instances IT CANNOT BE TAKEN BACK or credibly defended.
Most people who solicit my assistance through DCS have already made errors and clearly we can’t go back and change what is already done. But, we can go forward with a new perspective, re-positioning claims aimed at successful payment to maximum duration. The important point I’m trying to make is that most people do not know how to manage disability claims, but think they do, and mistakes are made that can seriously affect the outcome of claims moving forward. I really hate to see this. And, while some people reading this article may consider it as a “negative”, I’m really trying to help.
Here are a few mistakes that are made that are indeed unfortunate:
Using the Internet as a source of information.
Most of the information about disability claims on the Internet is bad news. Let’s face it, everyone has their own sob story. The truth is that all disability claims are unique and have their own sets of facts and circumstances. To transfer someone’s else’s claim management history from the Internet to YOUR claim is a major mistake.
Secondly, to download “old” forms from the Internet, and send them in to insurers should also never happen. One insured downloaded “old” forms containing AXIS I-V diagnosis and GAF score information that hasn’t been used for 5 years. Doctors who signed such a form at the insured’s request may not be considered credible after that.
Many insureds also “conduct their own research” to obtain court cases they can cite in their extraordinary long letters to insurers. This information is subsequently sent to claims handlers who have absolutely no idea what you’re talking about. Citation of court cases requires enough legal knowledge to know the difference between a District or Circuit court decision, what the jurisdiction of the decision is, and what it means to disability claims as a precedent. Citation of reference cases is only useful in court, and when provided by an attorney.
In reality, the Internet is just one step higher than the National Inquirer. It should never be solely depended on to manage claims, particularly by an unenlightened insurer.
If you think you know what you’re doing, you probably don’t.
You would be surprised how many “notions” people get into their heads that are just so outlandish I often wonder where in the heck the ideas come from. For example, if your doctor goes on a week or more vacation, you DO NOT have to find another doctor to treat you in order to remain in “appropriate and regular care” while your doctor is out of town.
Physicians are always taking vacations and a simple fax to the claims handler asking for an extension of time to submit paperwork always solves the problem. Insureds do not need a long list of physicians who treat for the same thing so insureds can bounce back and forth when they think they need to. Only current treating physicians need be disclosed to an insurance company, and insurers are NOT so STIFF that they refuse extensions when physicians are on vacation. Keeping alternative physicians “in queue” so you can use them when docs are on vacation is a very inaccurate notion, and should not ever be done.
Many insureds also believe they have to send in paperwork even when they are not asked to do so. Why? Insureds should always provide information ONLY when it is requested and ONLY what is asked. Insureds do not need to do the insurance company’s job for them. If an insurer wants information they will ask for it.
If you don’t understand your Plan or contract, you can’t manage your claim.
I think you would be surprised how many ERISA folks attempt to manage their claims without ever having read their Plans. Claimants cannot “punt” what to do when they have no idea what to defend. Even when insureds do read their policies, provisions are misinterpreted and wrong actions take place.
The best thing to do is make sure you have a copy of your Plan or policy and understand all of the provisions.
Making frequent calls, or writing long letters to insurers.
These two activities are major mistakes when managing claims. Unum, for example, has a list of “red flags” that includes frequent calls from insureds and claimants. In addition, writing long letters of explanation is often viewed as work capacity. Even when the insured says, “I had help in preparing this”, insureds are NOT believed and claims can be denied for the ability to write (type) letters, particularly if your disability is related to hands, wrists, arms or have anything to do with cognitive issues.
I think my readers are understanding the points I’m trying to make in this article. I understand entirely that insureds may feel competent to manage their claims, and some are successful. I wish that were true of every one.