Disability Claims Solutions

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Not in controlOne of the most hurtful aspects of disability is the knowledge that patients no longer have control over what’s happening to them. The loss of “personal power” can be devastating as insureds begin to realize they can’t control their inability to work, to participate in family functions, or take responsibility for their daily self-care.

To add more emotional trauma, many insureds fail to realize they do not have control over their disability claim, how its managed, or whether payments will continue to be received each month. Not having control over the important aspects of one’s own life can become a dilemma that causes insureds to adopt pessimistic ideas, and implement actions that are counter to the continuance of disability benefits.

The other day I had someone say to me something like this, “The fact that Unum wants to update my disability again is totally unacceptable. I’ve proven I am disabled and that should be enough. Please tell them I’m not going to send anymore information.” If I did what this insured is asking he wouldn’t have a disability claim for very long.

While I understand the arrogance expressed by this insured, it is nonetheless counter productive to a paid disability claim. There are those who are still so unfamiliar with the claims process that they put both feet into their mouths when communicating to insurance companies.

Therefore, I want to be very clear about a few things.

  • Disability insurance companies have the right to investigate and request updated medical and other information anytime they want. For ERISA claims, you have 30-45 days to submit the information at your own expense. IDI claimants have 90 days after a period of claimed disability to submit proof of claim.
  • Nearly all Plans and policies permit insurers to request an Independent Medical Evaluation at their discretion. If you refuse, the claim is denied.
  • Claimants do not control the claims process. You do not have the right to dictate WHEN your claim will be paid or UNDER WHAT CIRCUMSTANCES. Insureds may not attempt to control the claims process or interfere with the management of the claim, such as in contacting IME physicians directly.
  • Insureds may not make DEMANDS and expect that they be carried out by insurers.
  • Over speaking a claim and providing more information risks the claim, and DOES NOT MAKE IT MORE SAFE.
  • Downloading old, archaic and inaccurate forms from the Internet makes claimants come across as mentally challenged and uninformed. (GAF and AXIS I-V diagnosis isn’t used anymore and hasn’t been used since 2015).
  • Demanding or requiring treating physicians to validate diagnoses that YOU DICTATE risks a claim and DOES NOT MAKE IT MORE SAFE.
  • You do not have control over deadlines, peer reviews, short deadlines etc. We may “request” exceptions, which are largely approved, but attempting to decide for yourself what deadlines should be set is out of the question.
  • Doctor shopping with the intended purpose of controlling your own diagnosis and reporting never works. In today’s terms, it’s recognized immediately.

As an insured, it is important to realize that in order to have a successful claim you have to “work within a process” and position yourself as knowledgeable about adjudicating Plans or policies. My philosophy in running DCS, Inc. has always been about working with insurers to resolve issues to the insured’s benefit – long-term. Many of my clients have been with me 10+ years and were paid to the maximum duration of claims. This doesn’t happen by chance, there is a strategy to it that supports successful claims.

I have to wonder when insureds come to me after challenging an insurer and have received everything they asked for. The insurer gives in and agrees to resolve the issue, but yet the insured still wants to fight. What is THAT all about? Seems to me that on those occasions when insureds have met their burden of proof, and the claim settles down, maybe a victory lap is in order and the insured should stop fighting!

Rant! Rant! Rant! Argue! Argue! Argue! is NOT the path to a successful disability claim. When an insurance company agrees with you on every issue, it’s time to have some peace, continue to eye your rights under the Plan or policy, of course, but stop fighting.

Again, while I understand the reason why so many disabled persons feel they have to maintain control of something, a disability claim will not be possible to control. And, once you’ve won your arguments, be thankful and stop arguing. Insurance companies may do most things wrong, but they don’t everything wrong.

Sit down, take a breath and give yourself a break from trying to control your disability claim. It’s not going to be possible, at least not the way you think it is. Take it from one of the most successful disability claims Consultants in the country – work within the process, and when you win, take the victory lap and be silent.