Most insureds give the insurance industry way too much credit for common sense .In the insurance world, all paper processes have been minimized and downsized to the point of near non-existence. We’re managing claims that are overly diversified and those that are unable to pay much attention to 1,000 pages of medical information submitted by you.
This is especially true when it comes to reviewing “old” patient notes and other medical information that is older than 12 months. I’ve found that insurers are doing one of two things: 1) requesting all patient notes in an attempt to recreate the administrative record, (because they lost it) or, 2) they are requesting/reviewing only most recent medical notes because they don’t have the resources to go through all of the “old stuff; nor would they want to.
I want to be very clear about this. Disability insurance companies only want to know one thing. Ready? They are interested in only: “WHY CAN’T YOU GO TO WORK TODAY?” This means that insureds have the lawful burden of submitting proof of current disability.
What I see happening all the time is that insureds recognize that when they first went out on disability, their medical notes SUPPORTED DISABILITY. Even their physicians did a great job of writing R&Ls for total disability. Therefore, when medical notes are requested, there are those who continuously submit OLD information to support their claims. Contrary to what they believe the insurance company could care less about notes and “proof of claim” from 6-12 months ago, they want to know NOW why the insured can’t work.
There are times when claims handlers pitched OLD information in the trash so they didn’t have to have it in the file more than once.But today, no one cares why you couldn’t work yesterday; the insurance companies only care why you can’t work TODAY. They are unwilling to review paperwork that does not give them the answers they are looking for.
Another misstep of insureds is to submit the same information over and over again. Claims handlers are also apt to keep throwing it away. This is especially true for trying to file an appeal. OLD information isn’t helpful.
Rest assured that insurers are only interested in “NEW” medical information that support R&Ls and inability to work TODAY. You may want to keep that in mind when submitting patient notes and other medical information.
