Just A Reminder – An Appeal Is Not A Good Resolution, Avoidance Is

missed opportunitesSeveral times over the Christmas and New Year holiday I was contacted about assisting individuals with appeals. DCS, Inc. is a fee-based claims management consulting service that assists insureds to support and manage claims successfully. I prefer to avoid claim denials rather than dealing with the expensive aftermath of referring individuals to attorneys. So many people tell me, “I wish I would have contacted you sooner!”

I don’t believe any insured is looking forward to doing battle with an insurance company since, after all, the most any insured can expect is to have a paid claim. My services are more proactive and attempt to provide insureds with the maximum support and claim know-how so that all legitimate claims have the best opportunity to remain paid.

Unfortunately, once a claim is denied a 180-day appeal process begins for which attorneys charge up to 30% of back benefits and 40% of benefits to age 65. This back/forward fee schedule. While there are attorneys out there who are slightly more reasonable with their fees, they often do not accept ERISA cases, and/or cases with more challenging problems such as claims with cognition problems, mental illness etc. There’s just not enough money in it to encourage good attorneys to take the cases. 40% of almost nothing won’t encourage a good attorney to take your appeal.

The best solution is to avoid claim denials all together! Although this is not always possible there is something to be said for making sure the claim is managed with clear understanding of what private disability is all about, including the pitfalls. Some insureds call me to cleverly “pick my brain” so they can use the information on their own and I’m happy to give it. But, not all insureds who manage their own claims are successful with it.

I have also said more than once that attorneys are not great case managers. While they do what they do best – litigation, they are also very slow in taking ERISA cases and look to settle more so than they should. The easy way out is not always good for insureds’ pocketbooks.

“Missed opportunities” are costly. I recommend that insureds and claimants take the assistance that’s offered to them to save their claims rather than paying for high cost appeals later.

The only true successful solution to an appeal is to avoid it!