This article might just be one of the most important articles you’ll read concerning your disability claim this year. There are certain protocols, and understandings all insureds need to have in order to properly protect yourselves against insurers who are “stacking the deck” against you. So, let’s get started.
First and foremost is that all claimants and insureds should have copies of their Employer Plans or policy contracts, and have a clear understanding of the provisions. This is a major priority. Employers are required by ERISA to provide all covered employees with a “Summary Plan Description” of the group Plan within 30 days of coverage. It would be great if all employers did that, but if not, copies of the “SPD” can be obtained from HR. When filing claims, claimants can then request a full copy of the group Plan. Non-ERISA IDI contract copies are delivered to the insured at the time of acceptance.
All roads lead back to the Plan or Contract. Therefore, when individuals either do not know, or don’t understand the wording, they have nothing to “fight back with” and wind up PUNTING in the wind. Every complaint, criticism, or difference of opinion should always be backed up with citations from the Plan or policy. In the end, the Plan, or policy contract rules. I’m not trying to be smart or flippant here, but part of the problem is that many insureds and claimants need to arm themselves with better information about their coverage.
All insureds and claimants need to have a reasonable expectation of the limitations of their own coverage. For example, nearly all ERISA Plans have “changes in definition”, limited mental and nervous payment periods, SSDI benefit offsets, ERISA time lines”, and are subject to “discretionary authority” which gives employers the right to decide who gets paid and who doesn’t. IDI contracts still allow the employer to make decisions as to who “meets the definition of disability” making the contracts very risky future investments. No disability policy should be relied upon as financial security; they are far too unreliable for that.
Insureds and claimants should be prepared and willing to defend what they are entitled to. Providing an insurance company with ALL information because you think your claim will be safer is a falsehood for sure. Insurers always push the envelope for information they can use against you. The only information you are required to provide is financial, health, and occupational data. OVER SPEAKING a claim or volunteering family information is a mistake insureds may not be able to take back. I’m surprised how many people actually do that on Facebook or other social media.
Make sure you know what your Plan and policy says about DEADLINES for providing additional proof of claim. While it is possible to obtain extensions, I wouldn’t rely on getting those. Deadlines need to be met.
Don’t argue and rant to any claims rep, it’s a waste of time. And, claims reps turn the tables on you, and often document how “crazy you are.” Forget it. And, by the way, never “tell the story of your life.” Believe me, no one cares about that. Claims handlers are trained to selectively document what is useful to the company at the expense of anything favorable to you. Realize that claims reps are the lowest rung of administrative claims management; and treat them as such.
I will follow-up in a few days with Part II here, so please stay tuned.
