Many claimants and insureds are now report receiving letters or notifications by mail that are dated two weeks earlier. In addition, claims handlers are requesting updated information of all sorts using what I call “short deadlines.” Physicians are receiving letters and forms requests with return dates of 5-10 days. Claimants are desperately trying to work within those “short deadlines” when the request is OUT OF CONTRACT. Unfortunately, if there’s no push back, the claimant and insured musto is lost.
Here at DCS, I do not allow requests for short deadlines to prevail. Most, if not all, ERISA plans give claimants 30-45 days to provide “proof of claim” when requested to do so. IDI contracts give insureds “90 days after the end of a claimed period of disability.” (Every month is a “claimed period of disability.)
Physicians who receive requests for medical information go crazy when given 5 days to provide the information. ERISA provisions regarding returning update information also apply to your physician.
Trying to work within a 5-10 day “short deadline” is nearly impossible, but be careful here.
I’ve also seen examples where the insurance company initially requests a legitimate return date, which is NOT MET by the claimant; then, gives the claimant 10 more days to provide the information. This is legitimate. You need to look back to the original letter to count the days. I always hold insurers to the policy provisions when it comes to update due dates, and I’m recommending claimants do the same.
Incidentally, any letters or snail mail received by claimants and insureds should be dated and signed on the envelope documenting when it was received.
I don’t know when, or how it happened that claimants and insureds began to think that they don’t have to meet deadlines (when they are legitimate), by claiming, “I’m so sick I can’t do it”, or, “I hit a bad patch and just couldn’t fill out the paperwork.”
That’s not going to work. Claimants and insureds should NEVER miss deadlines using the excuse, “I’m so sick I just can’t fill out the paperwork.” Why? The insurance company doesn’t care how sick you are, and if you skip several deadlines, your claim will be denied. Yes, claim deadlines can be extended, but the key is keeping the claims handler informed as to why the deadline should be extended. BUT, IT SHOULD NOT BE BECAUSE YOU CLAIM YOU ARE TOO SICK TO FILL OUT THE PAPERWORK.
Legitimate reasons for requesting update extension is the unavailability of your physician within the requested deadline. Or, perhaps you need the deadline to coincide with your appointments. Nevertheless, I wouldn’t try to use the excuse “I’m too sick to complete the forms” excuse for missing deadlines.
If you would like to receive help with your claim, please feel free to contact me. If you are looking for additional information please visit my website located at: http://www.disabilityclaimssolutions.com, or email lindanee.dcs@gmail.com.
Tel: 207-793-4593
