There is a growing number of insureds and claimants who recently shared with me their frustrations with the disability claims review process after a period of time and working through the system. The requirement of having to submit frequent medical updates, fill out questionnaires, answer questions, and be fearful of IMEs and ultimate denials takes its toll from those who suffer from disabilities.
Having worked in this system on both sides of the fence for over 25 years, I can certainly understand what insureds go through to keep up with the endless battle of paperwork, and more paperwork on top of that. What I hear people saying to me is that they are tired of providing the same medical information over and over again. The process is burdensome, and causes anxiety and depression every time they are asked to do it. For some, even a letter from the insurance company sometimes sits on the desk unread for fear of bad news. And, it is a repeating cycle that never ends.
I have always suspected that as many as 50% of insureds are unaware what they are in for when they file a disability claim. I am still hearing from some that they think once their claim is approved, that’s it, with no further involvement. Of course, this isn’t true at all, and ALL disability policies actually speak to providing continual “proof of claim”. I need for you to really THINK about this: “there is no way any insurance company is going to pay you continuous benefits without continuous proof that you are disabled.”
In reality, the latest figure I’ve heard is that at least 30% of claims filed with insurers are actually fraudulent. The perception of disability companies, historically, always assumed at least a third of the claims filed are from those seeking secondary gain. All of the harassment, frequent updating, intimidation and risk management is an attempt to locate that 30%. Unfortunately, honest insureds get thrown into the barrel for no reason.
There is no free money. Of course, insurers will want to guarantee their benefit payments by making sure benefits are paid to those who are “proven” to be disabled. Insureds may not realize it, but when I was a Claims Specialist I found at least a third of my block of claims who had returned to work either part-time or full-time and “forgot” to tell me; and, many more who were awarded SSDI who also forgot to report it to me. Therefore, there is cause as to why insurance companies require the kind of updates that they do, and the frequency of them.
Another aspect of the process is for insureds to realize that one set of patient notes, or update forms, signed at a particular point in time, DOES NOT CERTIFY future disability long-term. Nor, does old medical information from the past certify future disability. It’s simply old news. Insurance companies want to know “why you can’t go back to work NOW, TODAY, OR TOMORROW, having already paid you for YESTERDAY.”
Now that I’ve given the rationale from the insurance company’s’ point of view, let me say that I totally understand from the insureds’ point of view as well. As a Consultant, I’m involved with insurance paperwork all the time. It’s almost harassing to just send in one set of update forms, when another claims handler comes along and requests them again. I get it, I really do.
<p class=”just”>But, is it worth giving up that monthly benefit for? I know some insureds tell me, “Linda, I want to give up my claim. Just tell them I’m withdrawing my claim. I can’t take it anymore.” And, insureds can do this if they want to. But, in todays world, and environment, I’m not recommending it. Every dollar of every benefit will be needed in the future.</p>
Therefore, it is important for insureds to find a member of their support group who can help them gather the necessary paperwork. Remember, most of this paperwork is looked at, and reviewed, then it is placed in a file, and not looked at again. Remember, it’s been my observation that claims handlers only read the top 10 pages of a file anyway.
Regular updates should be treated as normal and customary to the process. Forms change periodically, and there is no hidden message or Mal intent in changing forms. Go with the flow and don’t treat normal and customary updates as something suspicious, they are not.
<p class=”just”>The importance of a disability benefit makes it a high priority, and in my opinion, insureds should go the extra mile to do what it takes to keep that benefit coming. I know it’s hard sometimes, scary, and full of anxiety, but don’t throw away something without thinking it through. You’re worth it.</p>
