More insureds than ever are trying to manage their own claims to save money. I get it. Expert assistance is not cheap and it certainly isn’t free. However, there are several aspects of claims management that are absolutely essential for success. Therefore, here is a few free tidbits that may help.
It is essential for every insured/claimant to have a clear understanding of what insurance Plans (ERISA), and IDI policies say and mean. I still receive quite a few calls from both sides of the camp (ERISA and IDI), and it never fails to astound me that for many insureds, they don’t even have copies of their Plans or policies. Let me be very clear. There is no way anyone can defend their benefits and rights when they don’t have, didn’t read, or don’t understand the policy provisions. Every issue, every argument or conflict should always relate back to the Plan or policy.”I don’t know” isn’t a valid defense. If you are a claimant, or insured, it’s your responsibility TO KNOW.
Therefore, the first thing insureds need to do is make sure they have copies of their Plans and policies; read them; and understand the provisions. If you don’t do this one thing alone, your benefits are in jeopardy before you start.
The second most important thing is for insureds to make sure they have the best medical support they can afford. I’ve written several good posts recently defining what excellent medical reporting is. (If you missed these, please search from the Home page and read in detail.)
Since COVID, there are many physicians who are taking the conservative approach to certifying disability. On cue, insurance companies have picked up on this and have been contacting treating physicians with an agenda to persuade them to their point of view – namely that patients can work. More and more physicians are reluctant to sign update paperwork certifying totally and permanent disability.
And herein lies an enigma. Disability patients are sometimes reluctant to speak frankly with their physicians. And……it will depend on how you “position” your conversation that makes all the difference. As an expert in helping insureds “position” their discussions with physicians, I’m happy to help if you want to give me a call. Nevertheless, without the continued support of a good physician, there can be no disability claim, at least not long term.
And lastly….INSURANCE COMPANIES CANNOT HOLD AGAINST YOU WHAT YOU DO NOT SAY. This is why I have always recommended all communications in writing. I don’t think I’m being disrespectful when I say that insureds come in all sorts of personalities. Some, talk way too much. They may think, for example, that telling insurers the story of their life will protect their claims, or narcissists, who think they are going to control everything. It’s not going to work. Insureds need to strive for written documentation of every contact with insurers.
These are the most important aspects of claims management. I hope they help you, but if you decide you need additional help, please contact me.
