Disability Claims Solutions


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Happy New Year to all  readers of Lindanee’s Blog! 

While DCS, Inc. had a great year in terms of successfully managing claims with continued benefits for the majority of clients, a new outlook moving into 2021 indicates successful claims can be achieved by usiing a more positive mindset in the management process.

Historically, the Internet was, and still is, full of the worst possible case scenarios about this insurer and that one, scaring most insureds and claimants who are desperately searching for peace of mind concerning their own claims. Therefore, scared, and full of anxiety, most insureds go into the management of disability claims thinking their claims are already dead in the water without a chance of being paid. This perspective is like having to disprove a negative, which we all know is a battle uphill with an angry grizzly bear.

The overwhelming success of DCS,Inc.in 2020 involved working through any conflicts to find resolutions to problems, such as medical update requests during a time when most doctors closed their doors to COVID. The fact is, all insurers pay claims, and for some, they pay up to 60% of them. I don’t have exact figures, but in 2020 just from my own consulting business, I would place Sun Life at the top of the list for dealing fairly with insureds during problematic times. The worst being Prudential, who in the middle of the pandemic scheduled IMEs and ignored distancing.

This year, it will be very important for insureds to put aside any negative perspectives obtained from other sources, and take additional steps to be “on their game.” This means that insureds need to read their Plans and policies and be knowledgeable about WHAT THEIR OWN ACCOUNTABILITIES ARE with respect to coverage and beneifts. This is something we don’t talk very much about because there is always sufficient lip service given to the “bad things insurers do, to deny claims.” Insureds are more conditioned to “fight back against the horrible insurance swamp things”, than to take responsibility for the requirements they are responsible for themselves.

I am by no means suggesting that insurance companies will suddenly be managing claims fairly in 2021. However, many problems and conflicts arise simply because insureds fail to comply with Plan and policy provisions causing “failure to provide” problems. In addition, insureds need to know that claims handlers DO NOT MAKE CLAIM DECISIONS, and getting huffy with them does no good whatsoever. Behind the scenes is a claim manager who “validates” claim decisions. Claims handlers are at the bottom rung of the claims process and operate as “glorified Administrative Assistants”.

Finally, while KNOWLEDGE of the claims process is key, the “new mindset” includes the obvious – “be professionally nice”, and at least initially don’t assume the worst from insurers. Attempt first to resolve conflicts in accordance with Plans and policies, and look for solutions rather than believing going to court is your only option. Remember that the sad stories from the Internet won’t automatically jump off your screen into your claim.

DCS, Inc. places “conflict resolution” as a key objective and my position has proven itself successful. I strongly advise those who are managing their own claims, to adopt a more positive outlook, and take responsibility for knowing, and acting upon, all accountabilities outlined in their Plans and policies.

It’s going to be a great year!