Help Your Doctor Help You

I’d like to talk to you about doctor visits and getting your doctor to fill out the disability claim forms.  Doctor visits are some of the most important events in successfully filing a claim.  These visits provide much of the documentation and expertise needed for the insurance company to accept your claim and pay benefits.  Quick submission of the claim forms and payment of your disability benefits are obviously important to you.  But many, if not most, doctors are overwhelmed with patients and practice management responsibilities and can’t spend the necessary amount of time to fully complete your claim form on a timely basis.

Plus, doctors are likely not experts in how to complete your disability claim form.  They may not understand the nuances between different claim forms or all of the specific facts and circumstances involved in your disability claim.

If a doctor fills out your claim form and leaves critical pieces of data incomplete or missing entirely, your insurance company can, and will, delay your claim while repeatedly asking for additional proof and documentation.  There are several ways these problems can be avoided to get the disability benefits you deserve.

See a doctor immediately if you think you may be disabled.
The only way an insurance company will pay a claim is if the insured is under the care of a physician.  Also, be mindful of the language in your policy, as you may be required to receive “appropriate” care or be seen by an “appropriate” doctor.

Consider your work schedule before and after filing your claim.
Even after seeing their doctor and being thought to be disabled, some people will continue working while their claim is pending.  This creates a number of complications in the presentation of the claim to the insurance company.  Consider it from the claims examiner perspective – your doctor says you’re disabled from working…but you’re still working!  Understanding the requirements in your disability policy and how to present the disability claim to the insurance company can make or break your claim.

Most importantly, review (or even prepare) the claim forms yourself.
Nobody knows the symptoms and problems you are experiencing better than you.  Therefore, the simplest way to help your doctor provide what you need is to fill-in most of the claim form with legible and complete information before you give it to your doctor.  That way when you come in for your appointment, you can just review the form together, making sure the doctor agrees and completes the diagnosis and prognosis sections of the form.

We work with our clients along with their doctors to complete the claim forms in a clear, complete, and convincing manner.  Quite simply, it’s a better, stronger, more accurate approach that has resulted in more of our clients’ benefits being paid more quickly with fewer hassles.

We would love to answer any questions or read your comments – please feel free to comment below or visit our website for disability claim help.

The Definitions of Disability Claim Policies

There are many different definitions of total disability, all of which depend on the language in your disability insurance policy.  For a disability claim to be paid, your disability must meet the exact definition in your insurance policy.  Different policies can have different terms, so you can conceivably be totally disabled under one policy but not the other.   And public disability insurance – Social Security, state, and/or the VA – have completely different definitions and criteria.

In this post, I am going to give you some commonly used terms and what they mean for your claim.  Your specific disability insurance policy may offer variations of these definitions.

Own-Occupation Disability Insurance

Called Own-Occ, this is the most comprehensive definition of total disability:  the inability to perform the material and substantial duties of your occupation.  Your occupation is separately defined, usually as the duties you were performing at the time of disability.  There is usually a requirement to be receiving appropriate medical care and treatment as well.  Own-Occ allows you to continue or resume working in a different occupation and still be paid disability benefits.

Income Replacement Disability Insurance

Insurance companies that don’t have own-occ plans will often offer income replacement.  While income replacement plans seems similar to own-occ, they have a major difference:  you cannot earn income from any occupation and still receive disability benefits.  Under this type of plan, your disability claim benefit checks will be reduced if you go back to work in any capacity.

Any Occ and Gainfully Employed

These terms are the most common and are often used in group Long Term Disability (LTD) plans.  Any-Occ disability is usually defined as a sickness or injury that prevents the individual from performing any occupation that the insurance company deems the individual is reasonably qualified.  Gainfully employed sets a threshold that you can return to work but can only earn an income much less than your disability benefits.   Filing a disability claim under this type of coverage has many subtle areas where the insurance company can deny your claim.

So…Do not assume anything when it comes to your disability insurance and read your policy carefully, word by word.

No matter what type of coverage you may have, you should always be aware of your exact terms and definitions and how different circumstances may affect your claim.  When filing your disability insurance claim, you want to make sure the insurance company has no reason to question and delay your benefits, as this will lead to a long, arduous process and cause unnecessary stress and worry – when you’re already disabled!  For further information or comments, please feel free to leave a comment on the blog, or visit our website at www.RoyalClaimsAdvocates.com.

Welcome to Our Blog!

Disability Claims Consulting

Hello!

We are Royal Claims Advocates, a disability claims consulting firm dedicated to making sure insurance companies keep their promises and disabled individuals get what they deserve.  With more than 20 years experience working for disability insurance companies, our team has industry-insider knowledge of how claim examiners think, how claims are investigated, and how claims are paid or denied.

While we are not attorneys nor do we practice law or give legal advice, our team of experts understands policy nuances and the significance of certain inquiries that even attorneys and medical professionals don’t realize are critical in obtaining disability benefits.  Sharing the investigative techniques used by insurance companies allow our clients to be prepared.  As professional disability consultants, skilled and experienced members of our team prepare our clients for interviews, independent medical examinations, phone calls, as well as visits by field representatives and vendors.

This purpose of this blog is to share information and explore relevant ideas that make a difference in the disability claim process.  We are always listening for your concerns and questions regarding the complex world of disability insurance.  Please feel free to comment at any time and visit our website at www.RoyalClaimsAdvocates.com for further information.  Be sure to bookmark and visit this blog regularly to continue the dialogue on disability claims!

Filing a Disability Claim

Filing a disability claim is an emotional process.  While many people have disability coverage, no one wants to use it and few people are aware of the time-consuming and humbling process insurance companies use to validate your claim.  Many insureds feel helpless and upset but unsure of how to respond.

We understand this fear, and our experiences in the insurance claims defense industry provides our team with the expertise and knowledge to help you exercise your rights as the insured.  The insurance company entered into a contract with you — and you have a right to make sure they abide by that contract and keep their promises.

The claims process is designed to be intimidating and frightening.  Insurance companies want you to accept how poorly you are treated by insisting that they have the right.  But far too often, they don’t.  Our team knows their tactics and works to ensure that the insured’s rights are protected in every step of the process.  You do not need to fear looking over your shoulder, opening your mail, answering the phone.

We are here to stop the fear and intimidation created by the disability insurance companies.  We are here to make sure that you, the insured, are treated fairly and get the benefits that the insurance company promised when you signed their contract to protect your financial well-being.

For more information on our firm, visit www.RoyalClaimsAdvocates.com.  Also, please feel free to ask any questions or relay your own insurance experiences in the comments.