There seems to be quite a few insureds out there who are managing their own claims. As soon as I write an article remotely suggesting that’s not such a great idea, someone will email me a note saying, “But, I managed my own appeal and I won!” Or, I’ve managed my claim for years and there has never been a problem!”
While I’m happy for those insureds, they definitely do not represent a majority. Insureds and claimants are free to do what they want with their claims, but sometimes they do manage to SHOOT THEMSELVES IN THE FOOT, or as the case sometimes is “SHOOT THEMSELVES IN BOTH FEET.!
If you make the decision to file internal, or state complaints, it is absolutely necessary to make sure you are right and that you have Plan or policy provisions behind you, and that you have supportive proof in compliance with standard claims review process.
I’m really sad to have to say this, but sending in a complaint railing and ranting about how “the decision isn’t fair”, or, ” Unum did this, and Unum did that” will do nothing but make you look like an idiot.(For those looking for the walking eggshells, “It will make you look naive, and as though you didn’t know what you’re doing.”)
Despite what some people might think, there are protocol processes that must be met before disability claims are approved. “Tests”, if you will, that need to be passed in accordance with a hierarchy of review that logically makes sense. For example, if an insured doesn’t meet the 90 Elimination Period there is no sense in reviewing any medical information. Sending in a complaint saying Reliance Standard never reviewed your medical information when you didn’t meet the 90-day Elimination Period just makes you look, well, uninformed.
In particular, when you write complaints to state Departments of Insurance, you need to “get your facts straight”. Writing to the DOLs saying, “Unum didn’t do this, and my medical said that, and they ignored my medical information”, is nothing more than a RANT, and no agency or insurance company pays attention to RANTS.
Sending in a letter of complaint saying Unum denied your claim because there was no medical to support it (when there really wasn’t), again will make you look… uninformed. Wouldn’t it be better to tell the DOL in ME, “Unum ignored my medical information, and here it is?”
Remember the old adage “Doing the same thing over and over again will get you the same result?” Sending in the same, previously reviewed information will get you no where. Insurance companies look forward, not backward, and therefore, NEW MEDICAL needs to be submitted certifying disability TODAY.
Fifty years ago I can remember my father saying, “Well, it’s in the newspaper, it must be true!” Today, our newspaper is the Internet. Citing information from the Internet won’t overturn your appeal. In addition, citing court cases you find on the Internet is also ill-advised.
First of all, court cases are used as precedents to establish lawful intent for future cases. Cited cases on the Internet have jurisdictions, which could be limited to the State or Federal regions, which again may not apply to your claim. Lay persons aren’t going to know what jurisdiction a particular case applies to.
More than that, why are you citing court cases for claims outside the circle of litigation? Appeals reps won’t know anything about the cases you cite, and any state DOL will blow your cases out of the water. Citing court cases are best left to the attorneys who are litigating claims. If your claim isn’t in court, citing cases won’t matter anyway, and citing them won’t make you look smart or intimidate anyone. Stick to what is sitting right in front of you, (Plan and policy contract documents) and make sure that what you are arguing about is accurate and correct from facts, not rants.
There are a hundred ways from Sunday that insureds can navigate themselves down a wrong path. It’s generally not a good idea to complain and rant about a disability claim. It’s better to check your facts, make sure you are right in what you’re saying, and then back it up with Plan or policy provisions.
