We often have clients come to our firm not with specific questions but wondering about their insurance company and worried about having their disability claim denied. There is no simple answer to this issue. Every case is unique, and the best strategies are different depending on the circumstances. However, in order to better help insureds understand the claims process, we’ve put together a list of the most common mistakes made by insureds everyday.
- Filing an Incomplete Job Description
The job description is possibly the most crucial piece of evidence when filing a disability claim. It tells the insurance company the exact tasks your occupation entails and sets the stage to prove how your disability effects these responsibilities – the basis for many claim approvals or denials. Many insureds list their job title (like physician or VP-marketing) or just make a basic list of their general duties and responsibilities (like treat patients, organize meetings, complete paperwork and reports) when they could and should be detailing the many specific duties to provide the basis to show the impact of their restrictions and limitations. For example, if you have a herniated disc, your insurance company may assert that you can still “organize meetings.” Make sure the insurance company has proof of and understands the extent of your job duties. Include the details of what “organize meetings” actually entailed in your job, for example that that you had to travel by air and car all over the country to attend meetings, requiring hours of travel and much walking and carrying oversized materials. Your claim becomes much stronger with a more complete and accurate picture of your occupation, including those duties you are unable to perform due to your restrictions and limitations. Continue reading
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Social media is breathlessly changing the way our world communicates, shares news and pictures, and forms relationships with other people. Recently, there have been several articles in the news about how social media has been used by insurance companies to accuse people of committing disability claim fraud. Many people do not think about what they put on Facebook, Twitter, or LinkedIn, but claims examiners, field representatives, and private investigators sure do. These sites are some of the first (and best) sources of information used to delay or decline paying a disability claim. While Internet searches are not always misused in a claim investigation, the possibility for abuse is there by misconstruing what’s posted or putting information in a wrong or misleading context. This is why we educate our clients on how to be clear and careful about what they put online and how to have a consistent social media footprint when filing a disability claim.
It might sound funny, but Google yourself. Get an idea of what may be floating around the Internet about you. For another example, try Dirt Search and you might be surprised what one free, simple, quick public record search is able to find. Continue reading
Our understanding and treatment of HIV/AIDS has changed dramatically since it appeared in the public consciousness in the 1980’s. In its early stages, health providers and insurance companies often considered HIV/AIDS a terminal disease, but continuing advances in medications and treatments have changed the outlook to a chronic condition. In fact, the life expectancy for many patients in treatment continues to increase and is returning to the level of the overall population. But the disease as well as some treatments can still cause complications that make it impossible for people to continue working in their own occupations or otherwise. While a thorough study of this topic could fill volumes of books and still not be complete, I want to briefly touch on how the advances in treatment and the changes in popular belief on HIV/AIDS affect those who are trying to obtain their disability benefits.
Both the Social Security Administration and many insurance companies considered HIV/AIDS to be a terminal disease through the early 2000’s. This definition began to change as the HAART (highly active antiretroviral therapy) treatment, commonly known as the “AIDS cocktail,” became the prevalent course of action. A combination of at least three antiretroviral medications, the HAART treatment causes far fewer long-term and short-term side effects than previous treatments. This improvement has caused a change in the way disability claims resulting from an HIV/AIDS diagnosis were processed. Previously, these claims were readily approved as the insureds had high mortality rates, and the duration and amount of benefits was not expected to be very high. With more accurate classifications of disability claims from HIV as more of a chronic condition as opposed to those resulting from an AIDS diagnosis, claims resulting from HIV are beginning to receive much more scrutiny from insurance companies. Continue reading
In this blog, I often talk about the systematic approaches that many insurance companies use to delay or deny disability claims. Lump-sum settlements and buy-outs, while not outright denials, are another tactic that insurance companies use to reduce their benefits payments and write-off high dollar claims or claims with problematic issues. While we’re talking about settlements here, settlements can be defined as an offer and acceptance of a stated amount of money for giving up of all rights possessed by the insured under a policy contract to any future benefits along with the release of the insurance company from any liabilities from future disability claims.
Settlement offers can occur at any point in a claim but are usually brought up either after the company acknowledges liability or after a denial has been appealed, depending on when the offer is advantageous to the insurance company’s bottom line. The amount of the settlement depends on the reserves booked by the insurance company for your claim. Several factors, such as your age, health, discount rate, mortality and morbidity as well as any legal or compromising issues involved in the claim, go into determining the amount of the settlement the insurance company will offer. These same factors will help you determine if the settlement is beneficial to you. Continue reading
Over the past 15 years, insurance companies have followed an increasing trend of consolidation and product restructuring that has changed the landscape of disability insurance. Changes in philosophy can be traced to the 1990’s when Paul Revere was acquired by Provident, shortly followed two years later by Unum merging with Provident. Another large merger in this same time period was the Swiss Re acquisition of Royal & SunAlliance in 1999. Many companies decided to leave the disability market and sold their existing policies to larger insurers. These acquisitions allowed these large corporations to leverage economies of scale and have more resources aimed at higher but more condensed policy counts in their claims departments.
Large corporate operations have been formed that administer claims on behalf of the many smaller companies that are now owned. For example, an insured may still get correspondence on Provident letterhead but in actuality that letter is coming from a Unum claims department. There are many other companies that use this same tactic. This can enable companies to do business as firms with a better reputations and claims histories, all while pursuing aggressive claim denial tactics. Continue reading