I’ve been managing disability claims for over 25 years now and I can honestly say that “the official process of managing claims” has gone through many changes. Today, people seem to be bolder, more aggressive when they self-manage claims even though 20 years later they are less likely to know what they are doing.
Having said that, let me point out that there are many different types of personalities claiming disability benefits; each claim is unique and no two claims are the same. Still, there are certain identifiable groups of people who all seem to make the same mistakes.
The first “type” are those who have been programmed by their corporate working environment to have access to large data banks, and in fact, are encouraged to create and manage data as part of their jobs. This group includes Project Managers, Data Technicians, Technical Analyzers, Patient Data Clerks, or any other job where individuals supervise others,
I have worked for large corporations several times in my business career including Unum and I can tell you that new employees are quickly groomed with the “corporate lingo” and are often criticized if they don’t CORPORATION SPEAK inside the corporate box. It took me 6 months to learn UNUM SPEAK and about a year to forget it. “Silver thread” this, and “paradigm” that became a normal part of my every day speech until one attorney I worked for as an expert pointed it out to me, and asked me when I was going to stop using that language in my expert reports.
My point is that insureds just don’t forget all that corporate brainwashing if they aren’t aware of it, and frequently carry it forward to communications involving their disability insurers. I had several clients who meticulously kept one Excel spreadsheet after another with details about his claim. Nothing went “unwritten” somewhere. Sometimes it’s amazing how a person can do that, but not be able to work. That’s what an insurance company will think!
This isn’t necessarily bad, until it becomes a constant battle between insured and insurance company. As soon as one conflict is resolved, the insured will open up another disagreement about something in the claim. I recognize this because the “issue” is always backed up with copious amounts of detail (mostly misinterpreted) as to why the insurance company is wrong about something.
This is A HUGE MISTAKE.Why?
- The insurance company will identify you as a “red flag”. Frequent communication with an insurance company, or frequently “picking a conflict” is identifed officially as a “red flag.”
- The insurance company will conclude your behavior is mental and nervous and it will again declare a red flag to particularly document you are MENTAL.
- If you become a nuisance, the claims handler will not pay any attention to anything you say, even if you may be right about something. I have actually known managers to just “pitch anything written by a complaining insured into the trash.”
I have actually had clients who when they receive news their claims are approved, ask me to begin another conflict about something else. Instead of being happy and relieved about getting a check, the insured wants to start another fight. If the second issue is legitimate, then there is a time and way to mention it without getting into another conflict. But, if you’re managing the claim yourself, you will not realize NOT TO DO THIS, OR HOW TO DO IT, IF IT IS A LEGITIMATE ISSUE.
I’m going to be very frank with my readers about this mistake, and, as Dr. Phil is known to say, I’m going to put verbs in my sentences.” Your claim IS NOT AN OUTLET FOR YOUR ANXIETY, BOREDOM, OR CORPORATE SPEAK that you haven’t rid yourself of since you left the company. You are most likely not on expert in insurance policy adjudication, and misinterpretations make you look foolish. Constant finding of issues to “bicker” with the insurance company over is a risk you might not want to take.
General rule: Provide the insurance company with what they ask for and then, excuse my French, SHUT-UP. If you have a legitimate issue, such as benefit amount is wrong, wait until the next update and then tell them it’s wrong and why you think so. If it is wrong, I’ve never known an insurance company not to pay any retroactive benefits due.
The second type of personality that works against themselves are those who are usually receiving benefits for DEPRESSION AND ANXIETY or some other behavioral issue. Here is an example of when I begin to be concerned about a claim. Let’s say I’ve been trying to get in touch with a client for several days. They never seem to be available, “no can’t call then, nope not available…”, or, “friends are coming over, can’t talk”,,,,,,and on and on. Literally, I can’t get a word in edgewise. I begin to wonder (as the insurance company would if I weren’t managing the claim) “WHEN DOES THIS PERSON HAVE TIME TO BE DEPRESSED?”
While most therapists do include “staying active and social” during periods of depression and anxiety, by it’s very nature, depression and anxiety symptoms, severe enough to prevent someone from working include: tearfulness, fatigue, lethargic behavior, inability to think clearly etc. If someone’s day is so full of activity, how is it that they are sufficiently disabled to NOT be able to work? When there is no time to speak with their own consultant, there is definitely something wrong.
Sometimes people just don’t realize that when they receive disability benefits from an insurance company, they have to at least give some kind of semblance to the symptoms (and disease) they are claiming. Insureds can’t claim they are so disabled from depression they can’t work, and then run around all day and spend the weekend with family and friends. That’s not going to work. And, you can’t fool an expert consultant either! If you ARE depressed and can’t work, it should be reflected in what you do every day. If it’s doesn’t and you are too busy for a phone call, then perhaps a return to work should be considered.
I’ve been in the business of disability consulting long enough to know people are going to do what they are going to do. Although I am frequently asked by insureds, “What does a Consultant do?”, I have to say that what I do mostly is stop insureds from making mistakes they normally would make if I wasn’t hired to stop them. Unfortunately, that’s often true. This post is for people who are attempting to manage their own claims and are making monumental mistakes.</p.
I hope this post doesn’t offend you, because if it does, it probably means you’re doing some of the things I mentioned. Please think about what I’ve said here, and if you don’t get anything else from this post, please try to get rid of the CORPORATE SPEAK (if it pertains to you) – it really isn’t becoming outside of the corporate box. Get rid of the brainwashing and think for yourself.
