I have been receiving quite a few calls lately from insureds and claimants who seem to be acting against their own best interests. Granted, most do tell me, “I didn’t know”, but some things are just outside the realm of common sense.
One person’s story was, “I’ve been on claim now for over 15 years, but about 10 years ago my daughter, who is my dependent, received money having to do with COVID testing, about several thousand dollars. I’m so afraid my insurance company will deny my claim when they see my dependent made money.”
I don’t get it. The federal government sends out W-2 forms to the dependents who then include the income on their own tax return. There is no issue with this for someone with a disability claim. Why would anyone think that dependent income would have anything to do with disability earnings? This insured was having a great deal of anxiety over this one issue.
Another issue I’ve been seeing for the last year has to do with returning to part-time work, or working/volunteering on a regular basis. This issue is really getting popular, even though insureds are not handling it in ways that protect their back ends.
When you have a disability claim, you just don’t go back to work, in any capacity, and that’s it. Returning to work, full or part-time should be backed up with medical buy-in and support. Part-time work should always be medically backed-up with written, documented limitations as to frequency and maximum hours allowed to work.
Insureds and claimants really need to know what provisions there are in their employer Plans or policy before making any decisions to return to work. (Or, any other decisions, frankly.)
Here’s a good case in point. Insured X called to say she was trying to get back to work part-time. Horrified that her insurer would eventually deny her claim, she was pushing herself to “get another job as quickly as possible.” I asked her to send me a copy of her very old Paul Revere policy and lo’ and behold, her policy had no provisions paying benefits for “residual” disability. None. Her definition of disability also did not allow her to work part-time. Her policy was “all or none” for total disability. Had she gone back to work part-time, she would have been paid no benefits at all. Good thing we checked the policy.
Another recent case involved Claimant Z who continued working even though she had a really hard time doing her job. Because she continued to have difficulty working, she found it necessary to continue to reduce her hours over time to around 20 hours. Again, I suggested that we take a look at her Plan and again, guess what? Her Plan contained a “maximum hours worked provision” of 30 hours. If she were to file for disability now, her claim would be denied for not having met that provision. Of course, this claimant would need to increase her hours to 30+ for a period of time before going out on disability. Since she was currently working only 20 hours, she was not eligible for disability at all and any claims submitted would be denied. And, by the way, employers won’t always tell you about this either, and shouldn’t be relied upon to give you “safe” information.
My point is that claimants do not seem to be cognizant that there are many factors that need to be addressed when managing disability claims. “I didn’t know” probably won’t save your claim!
In the past, when claimants seemed to know all about “unfair claims practices”, at least there was some effort not to do or say things that would cause non-payment of benefits. Unfortunately, I’m finding that people today either “think they know” and act boldly doing the wrong thing, or, are talked into doing the wrong thing by insurers, or, focus just on the money and not what they have to do to keep it.
I’ve been writing blogs and articles for 25 years now, and there for awhile people seemed to “get it.” Today, I’m disappointed to say, that from what I’m seeing insureds and claimants are jumping in with both feet that often wind up in their mouths.
It is always important to know what you’re doing (how to adjudicate your Plan or Policy) when managing disability claims. And again, it could be the “fear factor” I always talk about in my blogs that is chasing people to irrationality with their claims.
It’s the “I don’t knows that will probably get you, but all insureds and claimants should make an effort to find out before they act. It’s getting harder, not easier to “figure it out” these days.I have no idea why insureds are doing weird things these days.
