There are still many insureds and claimants who are speaking on the phone with insurance companies looking for evidence to deny claims. Despite “best practice” recommendations, it appears insureds may feel more in control of situations if they speak directly to insurers. In my opinion, this is a very bad idea.
OK, so you’ve decided to speak to insurance reps on the phone anyway. Here are some of the things you should NEVER say. These are my recommendations based on my experience and expert status in the field of disability claims.
“I have good days and bad days.” This statement does NOT support disability status and never has. In fact, the statement is so generalized that it places “the disabled” in a category with everyone else on the planet who also has “good days and bad days.”
Those who ARE disabled should be able to describe specifically what their symptoms are. “My levels of pain this week have been “7” on the pain scale”. “Although I felt better two days this week, my functional capacity stops me from most activities.” Think beforehand how you would describe what’s going on with you, but don’t say, “I have good days and bad days.”
If you are trying to support a FMS claim, I wouldn’t say, “I hurt all over.”If you were to say this during an IME, it would be “gotcha” time. FMS patients do not “hurt all over” but have pain located in 18 specific trigger, or pressure points on the body. Instead, say,”I have pain on both of my back shoulder blades and behind my legs.” I recommend all FMS insureds become familiar with where the pressure points are, and be prepared to identify precisely where the pain is. There are a few excellent figure charts on the Internet.
“I was able to walk around the mall, but boy did I suffer afterwards for a couple of weeks.” Forget it. Insurance companies are of the opinion that if you did it once, you can do it always. Some people try to use this statement as an excuse when exceeding R&Ls after surveillance. Won’t work…..the statement can never justify pushing the envelope on restrictions and limitations.
“I’m going back to work in 6 months.” (Or, any statement projecting return to work.) When in comes to disability status, insureds can only deal with what is true TODAY. The truth is, just because insureds may WANT to go back to work, doesn’t mean that they CAN. Insureds and claimants should never set a future expectation for “return to work” because insurers will hold them accountable to any time set, and will harass about return to work forever. Only deal with what is true today, and instead say, “My doctor and I have no current plans for me to return to work.”
The lesson here is for insureds to either “zip it up”, or ask for all communications in writing. Sometimes you may think what you say is as “innocent” as it gets, but the mind of an insurance company works overtime to hold you accountable for what you say. Please think about this now that we are getting close to year-end profitability.