I have to admit I have no idea why some people retain my services and then ignore what I tell them. It’s just something that seems inherent to my profession, and although I feel sorry for the eventual denials that come back to me, there is nothing I can do if insureds make the decision not to do what I advise them to do.
Recently, I was informed of an initial claim denial, and the insured has reason to be frustrated and upset. I think Unum “jerked this guy around” quite a bit because he made the decision to speak with Unum directly, and called the claim rep many times. Contacting an insurance company often creates a red flag.(I think I mentioned that in the “red flag” post.)
Although the claim is fairly complicated, I won’t go into the particulars of his medical condition, but early on I advised him that his physician’s unwillingness to give medical restrictions and limitations would be problematic. In fact, paperwork suggested from one of his primary physicians was there he was not disabled at all. When I spoke to him about this, he insisted on just sending the medical information in, as is, to “see what happens.” The claim was denied, as I suspected it would be.
“Unum is no pushover”, I told him, “we need better medical information.” I don’t think this client actually did anything I advised, and there was a great deal that we could have done, if he’d just listened to my advice. Now, the claim was denied and he should seek out an attorney to file an appeal.
Most of the insureds who fail to listen to best advice are male physicians/dentists. I don’t know if it’s because they feel I’m below them, or because I’m a woman, but I’ve had three physicians in the last few months who do completely the opposite of what I advise them to do. I’ve also learned there is nothing I can do if people choose to close their ears to information that potentially helps with having successful claims.
simian
A couple of months ago I had another physician who listened to what I had to say and then contacted an attorney to “check it all out.” The attorney actually advised him to, well, let’s say stretch the truth a bit on his application forms. This Consultant doesn’t do that, so I never heard from the doctor again.
I really try hard not to use this blog as a selling venue for my services. but I have to say that after 9 years as a claims specialist at Unum, 4 years as an Expert Witness, passing a Maine State Licensing Exam, 85 depositions, and 21 years in the business of Consulting, that I KNOW WHAT I’M TALKING ABOUT. In addition to all that I have enough insurance alphabet soup to fill up a small room.
Despite my professional credentials, insureds continue to cross my path and ignore “best practices advice”; and, I still don’t know why.
As a slight aside, one of the insureds above absolutely insisted that Unum make a decision and pay him on the day after his Elimination Period. Let me respond, that when you file an IDI claim, “it’s not your show.” Insurance companies work on THEIR TIME, not YOUR TIME. I understand this may be irritating to some insureds, but the worst thing to do is continue to “bug the claims handler”.
Underestimating an insurance company is a major mistake. Anyone who thinks that they are going to “outsmart” their insurer, or over speak their claims rep, is in for a big surprise. Insurance companies don’t have to do what you tell them, and they usually don’t.
