In the last week alone I had three calls from claimants with denied claims looking for assistance. However, Consultants (by the laws in their states) do not have the option of taking on appeals and settlements – a concept I agree with. ERISA and IDI appeals are complicated these days and can be worth more than $2M in financial reserve. That’s not the kind of liability Consultants should take on.
Nevertheless, the best solution to a claim denial is to prevent it in the first place, and an expert in the claims process can help you do that. Once claims are denied, claimants and insureds have limited options that are often quite costly.
The attorney fees I’m hearing about are 30% of recovered back benefits plus 40% of future benefits to max duration of claim. If you sit down with a pencil and paper, and, considering the amount of the benefit, you could be paying six figure fees to an attorney to file an appeal or lawsuit.
Yep, the best strategy is to work with your consulting advocate to prevent a denial rather than to wait for the claim to be denied, as attorneys advise you. “Come back when you’re claim is denied, then I’ll help you.” Attorneys know where their money is, but in my opinion, that’s a load of crap. Most claims need to be saved now, rather than denied.
Therefore, if your gut is telling you your claim needs help, then you need it right away, not when the claim is denied. Please make sure your ship stays in port with solid claims advice and help from a Consultant. Insureds should NEVER wait until their claims are denied before taking all the necessary steps to defend their claims, Plans and policies.