One of the most helpful best practice articles I’ve written to date has to do with “Red Flags” and how to prevent the “suspicions” that creates them. You will find my former articles on the subject using the Search button from Lindanee’s Blog. However, I thought it would be a good reminder to mention “Red Flags” again since more people are attempting to manage their own claims and might get themselves into trouble.
My definition of a “Red Flag” as it pertains to disability insurance is : An officially documented list of activities and steps that will be taken by the insurance company to increase investigations of claims to resolve conflicting facts that are evident in the file.
It is not surprising that insureds themselves create “Red Flags”that makes management of their disability claims more difficult. Here is a short list of what insureds/claimants do to cause their insurers to conduct investigations far beyond what should be required.
The most frequent action by insureds that creates a red flag, is calling the company and claims handler frequently. Even if you have legitimate questions, contacting the insurance company on the phone is generally regarded as a bad idea. Insureds should never ask the opinion of an insurance company, and you can be sure it will contact you if it needs something. Frequently contacting the insurance company will put your claim first and foremost for increased investigations.
The second most frequent cause of insurance red flags is called “inconsistency of report. Although there are many ways “inconsistency of report” can get in the record, it usually occurs when the insured says or puts something in the record that contradicts physician’s reports etc. For example, conflicting physician’s medical restrictions and limitations with observed surveillance is also “inconsistency of report.” Any reported conflict of information creates in-depth investigation.
Anytime an insurance company attempts to contact you and can’t reach you at various times of the day, it is presumed the insured is working. This is one of the reasons why I always recommend written communications only. Occasionally, I find it hard to contact a client because they are not where they are supposed to be. Situations like this are potential red flags.
Interference by a non-disabled spouse, or an insured who is attempting to dictate the direction of a claim, is always considered a red flag. Persistent interference by a non-disabled spouse on the phone, or signing letters for the insured without producing a Power of Attorney or Guardianship Decree is an insurance red flag. As a general rule, non-disabled spouses should stay out of the claims review.
Finally, logging in to a website portal frequently is also seen as a red flag and claims have been denied for this reason.
No one wants their disability claim to be continually investigated. If you have any questions, please feel free to contact me.
