Tuesday Q & A

 

What do I do after my claim is approved?

This is actually a very good question. If you haven’t already done so, you should get yourself a cup of coffee and sit down with your policy and read it. Insureds cannot defend what they do not know.

Second, all communications between you and your insurer should be in writing only – and, not on any website portal either. Give yourself some time to actually think about your responses by putting them in writing.

Next, answer only questions you are asked, and do not offer or volunteer any information. Finally, if you run into trouble, get help. Don’t wait until your claim is denied before seeking expert help.

Does smoking marijuana affect my disability claim?

Well, that depends. If you’ve consulted with a state licensed marijuana MD who has prescribed MJ to assist you with your symptoms, such as chronic pain, then “no”, smoking MJ will not affect your claim. States that allow medical MJ have procedures such as issuing a MJ identification card, and requiring a prescription to buy it.

On the other hand, if you’re buying MJ on the street and are using it as a recreational drug, it could affect your credibility and your claim. Smoking MJ purchased without a prescription is also dangerous when insureds are also taking opiate or other depressive drugs. In fact, any drugs you take whether prescribed or not, should be managed by an MD.

On occasion, insureds call me and ask for advice because they are using meth amphetamines while taking prescription meds. My advice is to either present themselves to the nearest emergency room, or share the information as soon as possible with treating physicians. Taking street drugs while on disability is dangerous as well as unlawful.

There is a big difference between “prescribed marijuana” and buying drugs from thugs on the street. Insureds should never use street drugs while on disability. This also goes for alcohol that might also have an overdose effect for some prescribed medications.

Who is the “claimant” when you’re on FMLA?

The Family Medical Leave Act is unpaid leave that runs consecutive with most employer STD Plans. FMLA forces employers to keep jobs open and health benefits paid for a period of 12 weeks. After the 12 weeks, employers have the right to terminate if the employee does not return to work.

Employers have a great deal of lead way these days in allowing FMLA go on for more than 12 weeks, but in the end, employers can terminate employment after the 12 weeks have expired, and, with the blessing of the federal government.

I always refer to FMLA recipients as “employees” when discussing FMLA leave. The word “claimant” refers to those who receive benefits under an employers STD/LTD group Plan. Remember, that the two parties to a Group Benefit Plan are the employer and the insurance company.

Employees who file claims are referred to as “claimants”, “participants”, or “beneficiaries.” ERISA requires that they be provided with an “SPD” (Summary Plan Description), which is usually the first page in a “Certificate Booklet”.

However, if you’re really asking about FMLA, the recipients should be referred to as “employees” and those who receive group STD benefits are called “claimants.” Because both FMLA and Group STD run consecutively, in most instances the word “claimants” can be used for both.

Why would Unum offer a settlement on a disability claim?

Unum never offers settlements unless they have exhausted all of their “risk management” resources and have determined the company is liable for benefits to the maximum duration of claim. This is a good thing right? On occasion, Unum may offer settlements to an entire “block of claims” such as New York Life because they want to eliminate the liability for that line of business from its Balance Sheet.

In most instances, Unum is looking to eliminate the claim while at the same time making a 20% profit. The company’s practice is to not offer settlements greater than 80% of the financial reserve. Therefore, at least a 20% profit is realized on every settlement, give or take.

Unum never does anything unless it’s profitable. Always follow the money when trying to understand why Unum does what it does. Settlements are no exception.