Every one reacts differently to having a disability claim, and having to depend on insurers for income. Some learn to live in a high state of anxiety, some are tearful most of the time, others can’t sleep, and still others react arrogantly as if nothing is ever going to harm them. Bottom line, most insureds are just plain “scared” because they need the benefits to survive financially. And being scared, is the cause of many mistakes in managing claims.
Although the causes of the above are varied, in my experience insureds become symptomatic because of lack of information about the disability claim system, what the product really is, and what their accountabilities are within their own Plan or policy. Some insureds actually believe they know “everything there is to know” about their policies but when the rugs are ripped out from underneath, seem confused about what happened. It is very important for all insureds to have realistic perceptions of what disability Plans and policies are, and how to work within the system.
Here are a few reasons why insureds and claimants have emotional difficulty, and are often unsuccessful in dealing with their claims.
- Insureds and claimants aren’t aware that the written documents relating to disability insurance are flawed to begin with and do not protect or provide guaranteed long-term protection when unable to work. Plans and policies are averse to those who have them from the beginning. They aren’t freebies, and they are not safe long-term investments.
- Insureds fail to obtain copies of their Plans or policies, have no idea what the documents say, and fail to understand the provisions. Insureds are then forced to manage claims by “punting” their way through, and then become frustrated and surprised when things don’t work out well.
- Insureds frequently do not understand Plan and policy provisions and believe they mean what they actually DO NOT mean. Misunderstanding policy provisions is a frequent mistake.
- Insureds are often unaware that insurers record profitability by NOT PAYING claims and do not represent their best interests (fiduciary) at all. Insureds often ask their claims handlers what they should do, which is putting the foxes in their own hen houses.
- Insureds are often unaware that they are required to continue to remain in appropriate and regular care and will be asked to update medical information frequently. A “one time” certification of medical disability is not enough to continue to be paid. Updating medical information is normal and customary to the claims process.
- Insured not accepting that insurance surveillance is a real danger, and not acting accordingly.
- Failure to have frank conversations with treating physicians about potential doc-to-doc calls and what to do about them. Not having a common understanding about how to handle patient records requests etc.
- Insureds fail to understand what could happen by speaking with insurance reps on the phone. Anyone taking opiate, depression, or pain medications should never speak with an insurance company on the phone.
- Insureds who have severe symptoms of “claim anxiety” such as inability to sleep, high anxiety around benefit receipt time, checking website portals frequently, calling insurers, endlessly researching on the Internet, thinking about claims most of the day, insisting on confirmations that may never arrive…….etc. are not handling claims well.
- ERISA folks not understanding the significance of “change in definition” and “any occupation investigations.” These activities need to be managed, and are not just “go along with the flow” processes.
- ERISA folks not understanding 24-month mental and nervous limitations, the importance of “self-reported language” in a Plan.
- IDI insureds insisting their policy is “own occupation” when there is a “residual disability” definition of disability in the policy.
I probably could go on a bit more with this, but I think you get the idea. Disability polices are intended to be cash cows for the insurance industry, not products designed to help anyone who medically can’t work. Claims can be denied at any time without prior notice. Benefits can be reduced or removed to payback overpayments without prior consent. SSDI dependent benefits are additional offsets (deductions) from benefits. An insurance company can declare your disability “mental and nervous” related and deny benefits after 24 months.
ERISA Employer Plans give federal protection to insurance companies in the form of “discretionary authority”, which means insurers are permitted to decide for themselves who gets paid and who doesn’t, and even what the Plan means.(How fair is that?) Surveillance and speaking with neighbors is normal and customary. These are all activities that insureds and claimants must accept and work with while on claim. It is a never ending cycle.
It does worry me a bit to speak with insureds and claimants who unrealistically think they will automatically have their claims to maximum duration. That is definatley NOT the case. But, neither do I hear any insureds talking about what I call “Plan B”.
Plan B means that insureds and claimants have a well thought out Plan as to what they would do if their disability claim is suddenly denied. Where are your other sources of income? What local/state resources are available to you? Would you have sufficient income to cover current debt, or pay your mortgage or health care? What would you do if SSDI were suddenly stopped? What then?
Readers eyes generally glaze over when I start talking about “Plan B”, mostly because they don’t have one, and don’t want to hear about it. But, it is a reasonable concern, or at least it should be for most people. It’s my opinion that this is the primary reason why insureds are so scared all the time. What would happen if all income sources stopped? This is definitely something to think about. A “Plan B” is a really good idea. My dad used to say, “Always have another Plan in your back pocket.”
All insureds need to have a good understanding of what they are dealing with when filing disability claims. You need to know what you’re doing since everything with insurers is “how you position things.” You can’t “punt” a claim into long-term payment forever. And, please do yourselves a favor and give some thought to a “Plan B” for you and your family. It’s like having a bug out bag for when the SHTF.
Become familiar with the process and be smart along the way with a Plan B already thought out and waiting in your file cabinet.
