I’m not quite sure why insureds continue to defend their claims with inadequate proof of claim, or medical information that does not specifically cite restrictions and limitations. I realize that I may not reach all insureds with my articles, but I must have written 100 or more blogs about how important “restrictions and limitations” are to disability claims.
My critics say, “Linda, you repeat yourself, and write about the same things over and over again.” Hum…..yeah, I guess I do that, but only because insureds and claimants make the same mistakes over and over again. Therefore, I’m just going to have to say, one more time, “you can’t have a disability claim without medical restrictions and limitations.”
When I speak to people on the phone, it is often surprising to me that they will defend to the end a physician who writes on their form, “patient cannot work.” In my White Paper called, “Communication with your Doctor”, I describe in detail that these quickly written statements by treating physicians ARE NOT restrictions and limitations and the issue of “proof of claim” will never be resolved until the insurance company finally denies the claim.
Likewise, insureds can’t play 18 holes of golf and then complain because the insurance company observed you, and denied the claim. Or, you refused to send in patient notes. It’s just like trying to nail Jello to the wall – it’s just not going to happen! Still, insureds will defend to the end a physician’s statement that does not contain medical R&Ls at all.
Here is why I think insureds are reluctant to discuss R&Ls with their doctors:
- If the doctor is part of a large facility and operates on the 15-minute office call schedule, it may be impossible to speak with the doctor about medical forms and R&Ls. I get it. If this is the case, try speaking with the nurse manager instead. If this doesn’t work, find another doctor.
- Insureds feel intimidated by their doctors, who I’m sorry to say have terrible bedside manners. While patients depend on their physicians to support disability claims, when it comes to speaking out, insured’s feel scared and intimidated to ask their doctors to do anything.
- Insureds are afraid of “offending” physicians who have supported them in the past. Lack of R&Ls isn’t going to be unnoticed forever.
- Often, the patient is also a doctor. I imagine that would be very hard to do – for one doctor to tell another doctor about how to write R&Ls. That’s a very intimidating situation, but there are ways of addressing it.
- It’s not wrong to say to a physician, “My insurance company will deny my claim without documented restrictions and limitations.” Often, physicians are unaware how important this is.
I think you get the picture here. Bottom line, “no R&Ls, no disability claim.” What makes this article a bit different than others I’ve written on R&Ls is that defending poor medical proof of claim isn’t going to work, or, if it does, not for long. Just like surveillance excuses, “I walked in the Mall for a couple of hours, but I paid for that for two weeks”, doesn’t work either. Again, you can’t “nail Jello to the wall.”
With insurance companies recovering from COVID chaos and aggressively managing claims again, insureds don’t have a choice about sending in poor medical proof of claim. It won’t work, and the best practice here is to make sure YOUR medical forms contain good, solid restrictions and limitations. Don’t try to play insurers for a fool, they aren’t one!
