Due to the end of the year profitability results I have unfortunately seen several claim denials, which in reality should never have happened. These denials are referred to as “failure to provide” terminations. Insureds and claimants have a responsibility to provide paperwork requested by their insurers. When they don’t, it’s called “failure to provide”. What a terrible time of the year not to provide proof of claim since claim denials are nearly automatic.
All insureds and claimants have a contractual duty to provide “proof of claim” when requested to do so. The ERISA folks have 30-45 days to provide it at their own expense and the IDI insureds must provide proof of claim within 90 days of the end of a period of claimed disability. Contracts are legal documents and therefore insureds also have legal duties to do what the Plan or contract requires of them.
I know people frown when I point out the obvious, but no insurance company cares that you were too sick to take care of your paperwork. Although some insureds believe they are in control, believe me when I say that “YOU ARE NOT IN CONTROL.” I’m not trying to sell myself here, but this is why a Consultant can come in handy, because we generally know how to work within the system and put you, the insured out ahead.
Then again, some insureds are absolutely convinced that everyone is out to get them. They seem to float between lawyers (who tell them to come back when their claims are denied), internet articles, consultants, friends, family etc. without a solid game plan in place. Nothing seems to get done because they are always “too sick” to take care of business. While most insurance companies send out warning letters, insurers have no patience at the end of the year. The paperwork is either provided, or you’re out.
A “failure to provide” claim denial should never happen. If it is legitimately impossible to provide update paperwork as of the due date, contact the insurer and ask for an extension. I do this for my clients in writing only. While insurers do not always grant the extensions, most do, and more time is allowed. Knowing how to handle these situations will always prevent claim denials, the much preferred way of saving your claim.
Just please don’t tell an insurance company “you’re too sick to take care of your paperwork.” It is generally viewed as a very lame, lazy excuse and you may not get approved for an extension. Clearly, requests for extension should never be made near the end of a month, quarter or year-end. Timing is also important.
Again, “failure to provide denials” should never be allowed to happen. Keeping up with update paperwork is the most important duty any insured has with respect to his/her claim. It is always a good idea to make a real effort to provide proof of claim when requested as a general rule.