Disability Claims Solutions


Give Linda a Call

For the last twenty years, DCS, Inc advocated not speaking with any insurance representative on the phone. Out of over 1.2 million readers of the blog to date, I would estimate that less than half made the decision to follow that advice.

I believe that insureds’ fear causes them to believe that only direct contact with a disability insurer will ensure positive outcomes. While this was never true, today I’m finding that convincing people NOT to communicate spontaneously with any insurance company on the phone is one of the hardest best practices I’ve ever had to write about because people just don’t listen.

Therefore, I think it would be a good idea for me to explain further why it is NEVER a good idea to speak on the phone with insurance reps.

In the beginning, a good rationale for refusing insurance phone interviews was that management developed templates containing  “sets” of questions they wanted claims handlers to ask and document for the record. The approved questions encouraged claimants/insureds to “give away the farm” so to speak by providing personal information about their activities that had nothing to do with disability claims. And, while I support not communicating on the phone for this reason, I also support a more medical practical approach as well.

Nearly everyone who files disability claims is prescribed medications that cause reactions in many different ways. Whether the medication is an anti-depressant, pain killer, or anxiety drug, the affects of taking opioid or other cognitive-affecting drugs whether noticed or not,   prevent insureds from responding spontaneously to drilled questions in any credible way.

Furthermore, Insureds NOT taking medications are likely dealing with varying degrees of pain throughout the day and again are not credible spokespersons to defend disability claims. Insureds always think they can “handle it”, but in the end information is shared that could risk payment of the claim. Think carefully about this…..answers you give on the telephone affect future payments of your claim. Are you willing to risk it?

Lastly, I think insureds just say the wrong things because they try to defend the credibility of the claim and sincerely believe that by sharing as much information as they can, the claim will be paid. THIS IS NOT TRUE. The more information you give a disability insurer, the more info insurers can use to support non-payment of claims.

But, let me be clear. Insureds and claimants are required to provide their insurers with honest information they need to investigate claims on an on-going basis. However, beyond that, there is no contractual basis for insureds to voluntarily provide information that puts claims at risk. Phone conversations with insurance claim personnel are a very risky activity that should be avoided at all costs.

In addition, there are no contractual or Plan provisions requiring anyone to speak directly with any insurance company on the phone. Why do you think insurers are all too keen about contacting you on the phone to begin with? Insurers never do anything without specific objectives and motives, and you can be sure the “gotcha” tag is all over this.

Unum in particular tries to use old policy IME provisions to say that insureds MUST speak on the phone, but that’s ridiculous. Allegations that Unum has considerable discretion in IDI contracts is a FALSE claim since there is no ERISA discretion, and contracts should be adjudicated as written.

While I personally can’t stop people from giving interviews on the phone to insurance reps, knowing why these calls are so important to insurers should deter anyone from participating. Still, if you choose to take the risk of “not getting it in writing”, then you should be quite calm if and when the claim is denied.

Believe me, I’ve seen the denial letters all too often, “Based on our phone conversation you said………….” Ouch! They gotcha!