In the last few months readers read several posts from me describing the awful claims situations they may find themselves in. If you don’t remember, please review my posts for the last month or so. The question I’m guessing many people have is, “OK what do I do now?” Read on….I’m going to tell you.
First and foremost, it is absolutely imperative to have frank conversations with treating physicians to gather information about how THEY intend on managing the frequent reporting required by insurers. Don’t assume you know, and don’t assume your doctor knows. Make it clear that you don’t give permission for him/her to speak with any insurance doctor on the phone. Ask the doctor if it is going to be a problem writing restrictions and limitations.
Next, ALWAYS as your doctor to let you see what is being faxed back to insurers before it is faxed. Ask for a copy of it. Insureds and claimants aren’t in control of very much when it comes to a disability claim, but you can control what information insurers actually get. I have found in my experience that physicians who fax directly and take phone calls from insurance docs often throw their patients under the bus. Don’t allow that to happen.
Avoid the temptation to be reactive. If you react by calling the claims handler, or notifying the DOI prematurely, or “shooting your mouth off” in any other way, you are hurting your claim, not helping it.The issue is to resolve the conflict by adding Information to the file. Be prepared to back up what you say. But, the primary issue is to resolve the claim conflict by not being over-reactive. Not every issue is a deal breaker.
Remember, today claims handler are mostly foreign, don’t speak English very well, and read only, maybe the top 10-20 pages of a file. If you asked them to give you all communications in writing about 30 pages ago they probably won’t see that. Be persistent and don’t let insurers wear you down.
Manage the paperwork. Always ask for a receipt confirmation and follow-up when you don’t get one. Take names if you can get them, ask for managers’ names and keep a journal documenting everything. Unfortunately, you have to do the work for all insurers who use, “We didn’t get it!”, as an excuse.
Listen to the people who know. Twenty years ago everyone listened to me. Today, I’m guessing about half of my recommendations are scrubbed.Some time ago I told a caller I felt his doctor’s medical information would be insufficient for an approved claim. He said, “I don’t care I want to send it anyway.” His claim was denied. I’ve said many times that sometimes I hate it when I’m right, but the truth is, there are people out there now who do not listen to best advice. When I say, “I don’t think this physician will be a good supporter of your claim”, I have reason to say that. Still, I think about half of the people I speak to dismiss my recommendations and risk denials they did not need to have.
These are just a few of the actions I’m recommending to insureds who manage their own claims. DCS Clients receive a great deal of help with all of the above. If you would like to have more information please feel free to contact me.
http://www.disabilityclaimssolutions.com
