Great Internet Resources

Taking advantage of the resources on the Internet is a great way to stay “in the know” and help understand what is happening in your disability claim.  Whether you are an insured or an agent, the insurance companies try to use the claims process to their advantage by frequently tweaking policy interpretations and creating unnecessarily complex procedures and processes as hoops to jump through to obtain disability benefits.

Here are a few resources that are useful to help comprehend what you’re up against in the claim process and provide some information on different types of disability coverages:

  • Insurance Consumers – Disability Insurance:  This website is a great overview of disability insurance, from obtaining a policy, to filing a claim, to understanding the claim examination process.  It’s a great starting point for understanding disability insurance.
  • Social Security Disability Resource Center:  While our firm does not normally handle Social Security claims, many of our clients are required by their insurance company to also file for Social Security disability benefits.  This resource has proven useful for people to understand that separate process.
  • “Trust Law as Regulatory Law: The UNUM/Provident Scandal and Judicial Review of Benefit Denials under ERISA,” by John H. Langbein, Professor, Yale Law School:  If you have the time, this is a very interesting (but long) legal academic study on the UNUM controversy from a few years ago.  A very informative and eye-opening article on bad faith practices in the insurance claims industry.
  • LifeHealthPro – Disability:  This is an up-to-date listing of current events and news articles about disability insurance, Social Security, and other aspects of the disability world.  It is a good resource for current issues in the industry and to keep track of new developments.
  • Insurance Forums:  This forum is a great place for agents and consumers alike to ask questions and find information on a range of different disability insurance policies and companies.

These are just a few of the many resources available on the Internet to help you better understand disability insurance and the disability claim process.  Knowing more will help you take ownership of your disability claim and give you a fighting chance with the insurance company claim department instead of going to them, blindly assuming that they’ll pay you fairly, accurately, and timely.

Realizing the underlying reasons for the actions of the insurance company along knowing and exercising your rights are vital to a successful disability insurance claim.  If you would like to share any other good resources or want to comment on the sites provided here, please do so in the comments section!

As always, you may visit our website or call us at 855.828.4100 for more information on how our firm can help you!

UNUM Success Story!

A 56 year-old surgeon, suffering from arthritis and lumbar disk problems, had become uncertain whether he could remain in a surgical suite for sufficient periods to complete all of his surgeries. To compensate for his chronic pain, he reorganized his responsibilities to assisting on some surgeries and doing more clinical work, including pre- and post-op patient visits. He was in a multi-physician practice that was able to accommodate his changes by rearranging duties and work schedules.

The surgeon bought a UNUM disability insurance policy in the early 1990’s that provided for $12,000 of monthly benefits and had faithfully paid his premiums. Since he was no longer performing most of his surgical procedures due to his pain and weakness, he realized the only way he could maintain his income would be to file a disability claim with UNUM. The office manager of the practice contacted their insurance agent, who referred her to the claims department. Claim forms were obtained, completed, and submitted.

After almost 75 days of repeated telephone calls and letters back and forth, UNUM denied his disability benefits due to ambiguity in the symptoms, unclear medical proof of the claimed conditions, and an unduly broad inclusion of occupational duties.

A mutual friend mentioned our firm to the very upset and frustrated doctor. After calling and meeting, he decided to engage our firm to go through the documents that were already submitted to UNUM. We worked with the doctor to prepare a much stronger, more detailed, and clearer disability claim. After working with the insured, his practice manager, and his attending physicians, we were ready:

  • Complete and detailed descriptions of his occupational duties were prepared.
  • Additional tests were performed to document the claimed conditions.
  • A clear and fully documented history of his disabling conditions was written.
  • Letters were written explaining the errors that were made in evaluating the originally submitted claim.
  • Claim forms were completed again with the additional, more complete, information.

Finally, all of this information was compiled and presented in a manner that was easy for the claims examiner to review and accept…which is exactly what happened!

Our client started receiving his monthly disability benefits within 2 weeks, plus 9 months of retroactive benefits. His only regret is that he didn’t use our firm from the beginning! His benefits are still continuing today, more than 7 years after starting his claim. Of course, we’ll check in or he’ll have questions from time to time – as the claims process never stops. But, he’s been able to collect on the promises made when he made the wise decision to protect his income in case of disability.

This case is just one of the many examples why you should never give up when an insurance company denies your disability claim. With the standard operating procedure of “question then deny,” many companies exhaust their insureds into giving up when they get the dreaded denial letter. With our help, clients can easily handle the mass of paperwork and communication the insurance companies use as weapons to deny claims.

We welcome and encourage your comments on this blog. If you would like to add your own experiences, please share them!

Really, it’s a “win-win” ?!?

The term win-win has become a cliché but still applies in some scenarios.  Some of our best and most satisfied customers are agents and brokers.  Working with us is a win for both the agent and the insured — and frankly, the insurance company as well.

One of the main goals of an agent is to keep their current clients happy in order to generate goodwill and referrals.  A great way to achieve that goal is by helping their clients, at their greatest time of need when a disability has struck and the claim process is unfolding, see that their claim is paid in the best and easiest manner possible.  That is where and when a referral to our firm can make a positive difference.

When a disability claim is filed, the promises made when the policy was bought and the reputation of the agent are put on the line.  The client sees the agent as an extension of the company, but claim departments view the agent as just a parrot for the insured.  Neither is true – but the agent is still stuck in the middle.  An agent’s reputation is priceless.  Royal Claims Advocates allows the agent to get out of being trapped in this no-win situation between his client and the insurance company and enhances the agent’s reputation as a skilled professional.

Our firm is focused solely on helping insureds throughout the country get their disability claims filed properly and making sure their policy benefits are paid in full and on time.  We don’t compete with agents or sell insurance products.  We work behind the scenes with our clients, simplifying what can become a very cumbersome and lengthy claim process and making it easier for insureds to obtain their rightful benefits without undue stress and strain.  The insurance company gets the information needed to process and approve the claim without extensive reviews, invasive demands, and protracted delays.

The ease in which clients are able to go through the claims process and collect on the promises when the insurance was sold reflect on the agents.  Clients come to see their agents as trusted resources, professionals who are able to ensure that promises made are promises kept.  All this takes is for the agent to make a simple connection between the client and our firm, when our services can be of assistance.

When a client contacts them about filing a disability claim or has difficulty dealing with the claim process, agents refer those clients to us.  Our team of experts – medical, occupational, investigative, and financial – immediately start working to understand and address their concerns.  Recognizing the trust placed in each party, agents are kept in the loop throughout the claims process.  Clients’ service expectations are not only met but exceeded by our consulting services.  The time, energy, and resources of agents stay focused on their core business, which is not the adjudication of disability claims.

A disability claim that is clear, concise, and complete produces a “win-win-win” situation, for the insurance company, the insured, and the agent.  The insurance company saves time and expenses on the claim adjudication process, which reflects positively back on the agent as well.  There is no downside for an agent or broker to refer a client to us.  We make sure your clients receive their promised benefits, improving your professional reputation, at no cost to you!

If you are an agent or broker and would like more information on our firm, please visit our website or give us a call at (678) 828-4100.

The Profits Behind Denying Disability Claims

Happy New Year! I hope your holidays were enjoyable, and we wish you and yours a very happy and prosperous 2012.

Many people realize too late the voracity of which insurance companies attack insureds’ credibility and practice a policy of deny first, ask questions later.  What many people do not understand are the reasons why.  Practical business sense says that putting your customers first and practicing strong customer service will keep customer loyalty.  Insurance companies follow these rules when selling and updating their insureds’ policies.  But these rules are at best only given lip service in the claim departments after a claim is filed.  Our first post of the year is going to discuss the reasons behind the change in rules once you’ve filed your disability claim.

Since the late 1970’s, insurance companies actively marketed “own-occ” policies to white-collar professionals.  These people were specifically targeted because they were less likely to stop working due to the time they had invested in their education, high salaries, and enjoyment of their careers.  These policies, in addition to paying if a claimant could not work their specific occupation, were also non-cancellable, and the premiums were fixed.  These policies became very popular!  The market became more competitive with more insurance companies offering more attractive measures, such as reducing underwriting standards and lower prices.  Other features – coverage without a detailed medical history, no mental health exclusions, lifetime benefits, and 6% cost of living increases – were also added to policies, resulting in a “boom” of sales.

The economic expansion and investment returns during the ’80’s and ’90s enabled insurance companies to invest the premiums from these liberal policies and earn substantial returns.  These returns were predicted to continue but stopped after the late ’90s.  At the same time, the income for many professional careers grew stagnant and even declined in some specialties, which caused many professionals to reconsider whether they should continue working through their disabilities and instead file for benefits on their disability policies.  This sudden influx of claims coupled with the declining rates of return on the invested premiums turned the “own-occ” policies into a very unprofitable field, costing insurance companies millions of dollars.

This lack of profitability caused insurance companies to start focusing on the “management” of these claims in order to make the policies profitable again.  Insurance companies started reviewing claims and looking for every and any reason or interpretation of policy language they could use to deny otherwise legitimate claims.  Policy forms were revised, and new reasons were constructed to deny benefits.  Claim payments were slowed down or even stopped while investigations were ramped up.  The methods that came about during this period are well known today to insureds who have gone through the experience of filing a disability claim: lost documents, unannounced visits, field interviews, “independent” medical exams, financial audits, surveillance, and many other dubious tactics.

Insurance companies have realized the profitability of fighting claims, which has developed into its own billion dollar industry.  We know – that’s where we were taught all about disability claims and how to “defend” against them.  This is why insureds must stay vigilant and why advocates are often necessary to get a disability claim filed properly and benefits paid quickly.

A publicly traded insurance company reports to the stockholders, not its insureds.  Even mutual companies construe their attacks as simply defending the interests of their policyholders.  The most important numbers aren’t your rightful disability benefits —  it’s their bottom line.  Claim departments in insurance companies have the resources to come up with excuses to deny otherwise valid claims.  Don’t let yourself become one of their victims.  If you have questions, please visit our FAQ page.  For more information on obtaining help for your claim, check out our services.