Disability Claims Solutions


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Most people who file disability claims seem to think that providing claims reps with as much detail as they can is the best way to insure successful claims. Nothing could be farther from the truth since “detail” doesn’t usually provide successful claims.

In fact, disability insurance companies deliberately set up communication strategies that prompt, persuade and pressure (“the three P’s) insureds into providing sufficient detail info so that claims can be denied sooner rather than later. From the insurance companies’ perspective there is nothing “nicer” than getting insureds to doom their own claims with detail since it is unlikely denial decisions will be reversed on appeal when insureds throw themselves under the train.

In my opinion, the tendency of insureds to OVER SPEAK claim information derives from:

  • Fear of not getting paid.
  • Fear of accusations of not being forthcoming with information.
  • Attempts to “justify” and defend claims as credible.
  • Mistaken beliefs that the more information provided, the safer the claim is.

Disability insurance companies thrive on information that has nothing to do with disability claims. Anyone who has ever received a “questionnaire” knows exactly what I’m talking about. In truth, the only questions the insurance company has a right to ask are those about:

  • Your occupation.
  • Your finances.
  • Your medical restrictions and limitations that prevent you from working.

Think back to all of the information you’ve already been asked that you gladly provided answers to already. Questions about gardening, laundry, computer usage, visiting friends and relatives, how long you sleep, where you travel, etc. I’m betting that most insureds reading this post readily gave the information and didn’t think a thing about it!

The insurance company has right to know about your job/occupation description because of the “definition of disability” provision in all Plans and policies. They also have a right to know if you’ve had an earnings loss of at least 20%; and, of course, what medical restrictions you now have that are preventing you from working. Any other questions about your activities are specifically designed to allow you to give your own work capacity definitions. It continues to surprise me that most insureds do not understand the folly in what they say.

When it comes to disability insurance, “less is definitely more.” For example, “Yes”, “No” and “I don’t know” are still very good answers. Insureds shouldn’t try to think of an answer just because a question has been asked – a big mistake during field interviews.

Another good example is when insureds are asked about medical “restrictions and limitations” – a question insureds should never attempt to answer. The answer should be, “My physician has already provided medical restrictions and limitations, please refer to my file and his/her documentation.”

Attempting to get insureds to make statements about their own R&Ls is a strategy since most insureds simply just try to make them up on the spot. Don’t do that!

Finally, there’s the ultimate ridiculous question nearly every insurance company asks, “Please describe a typical day for you.” What the insurance company wants you to do is begin with, “I get up at 8 a.m., have my orange juice, work on the computer, sleep”, and then a half hour later, after every single detail and bathroom break, you finish with, “I go to bed after the news.”

Consider the amount of detail you just gave to an insurance company that has absolutely nothing to do with your claim. Hum. The insurance company just got you where they wanted you.

Isn’t it interesting that disability insurance companies will never ask you more relevant questions such as, “Please describe what occupational duties you are unable to do and why.” Asking a question like this would be in favor of insureds and payment of claims, therefore, the question is never asked. In the end, insureds will only be asked questions that prompt detail that can be used against the claim.

In truth, not even healthy people have “typical days”; the question states a wrong premise, and insureds, naively run with it! A more truthful answer to this question might be, “I’m sorry, but I don’t have “typical” days. My days vary in accordance with varying levels of pain, fatigue and confusion (whatever pertains to you).” Isn’t this response closer to the truth for most disabled persons? Or, any person?

The general rule is for insureds to provide honest answers only to questions that are asked, and to avoid providing detail that has nothing to do with the inability to perform one’s occupation due to medical restrictions and limitations.

Finally, stop talking about your claim history over and over again. Here is a good tip you can take to the bank……Any information, fact, or medical history you’ve provided in the past contributed to the payment of your benefits AT THAT TIME. Insurance companies aren’t interested in why you couldn’t work 6 months ago, they are only interested in why you can’t work today! Insureds need to stop rehashing old news because insurers don’t care about periods of time they already paid you for. All insurers are interested in is why you can’t work TODAY, and why they should pay you MOVING FORWARD. If you take anything away with you from this article, this should be it.

I know for some personalities it’s difficult to stop talking. Sometimes I literally have to stop insureds on the phone and ask them to, “take a breath.” Still, given the risks involved, it is far better for insureds to communicate with insurers in writing only to avoid OVER SPEAKING claims.

Whatever method insureds choose to communicate with insurers, it is important to acknowledge the deliberate pre-planning on their part to devise strategies that encourage the exchange of activity detail in order to deny more claims.

Never OVER SPEAK claim information, only provide honest answers to what was asked, and stay away from frivolous activity descriptions. You don’t have to answer a question just because one was asked; don’t try to make up answers on the spot. If you don’t know, say you don’t know; defer to the file, physician or employer information, and only provide what is required by the Plan or policy.

Providing insurers with an overwhelming amount of detail is one of the most dangerous mistakes insureds make. My recommendation is to avoid OVER SPEAKING your claim with a great deal of detail. Insurance companies cannot use against you what you do not say.