In the last month or so I’ve been contacted by several people looking for appeals help because their claims were denied, mostly ERISA. Unfortunately, I am not permitted to be “out front” for claimants or insureds on appeals, but am only permitted to advise and help insureds behind the scenes.
While insureds do have the right to represent themselves for claim appeals, it’s never been something I’ve recommended. In fact,I’ve written several articles on Lindanee’s Blog advising people that the best defense for a claim appeal, is to avoid the denial in the first place.
And, herein lies the difference between what a Consultant does versus what an Attorney does. Consultants assist insureds and claimants with managing their claims in ways that would make it very difficult for any insurance company to deny. In fact, any issues involved with client claims would require your Consultant’s review and input.
Everything with an insurance claim depends on how you POSITION things.And, most Consultants are contract specialists.
Attorneys do have a role in the disability claims process after the fact when, or if, claims are denied. Appeals and lawsuits are what they do best, not claims management. Again, the best case to win appeals is to not have a denied claim in the first place, and Consultants can usually accomplish that.
Still, apparently there are many insureds who ARE managing their own claims, probably due to the cost of living in our world today. I’m also finding that even when people do hire me lately, it is to work in a “secretary” role, filling out paperwork and nothing else. These are mostly highly paid medical insureds, doctors, surgeons, specialists, who seem to think “they know best.” This is really a mistake.
Most Consultants have actual hands on claims experience as well as other insurance credentials that lend themselves directly to the claims process. Unfortunately, in the area of disability claims, insurance companies are “equal unemployment disability deniers ” and being a doctor, lawyer, dentist, or surgeon is no protection when you don’t know what you’re doing.
Therefore, if you believe you need help with your claim, please call me BEFORE a denial, not AFTER. If your claim has already been denied all I can do is refer you to a good attorney to process your appeal. While I can’t help you if your claim has been denied, I might have been able to assist in keeping your claim in pay status, even when there are no guarantees to disability claim outcomes.
Think about it.
