Defining and Decoding “Appropriate” Care

Disability insurance claim examiners often bring up the issue of “appropriate care” when questioning benefit claims and often use this same term as an excuse to deny claims.  Many claimants do not properly understand this term and how it can be used by the insurance company to manage your disability claim.  Older disability policies used to require that a claimant be under the “regular care” of a physician and required little more.  As insurance companies seek more control over disability claims and their direction, this policy language has been changed to “appropriate care,” which has a much more stringent definition.  Regular care was usually based on a time perspective, ensuring disabled claimants were receiving some sort of recurring medical treatment.  The shift to “Appropriate care” has given the insurance companies the liberty to retain their own experts to decide if the claimant’s choice of treatments or physicians is “appropriate” for the condition. 

The motivating factor behind this change is control of your disability claim.  If insurance companies have the latitude to decide what care is (or isn’t) appropriate, they can influence your medical care and treatments with the goal being to reduce the length and amount of the claim, either by discounting the medical support presented by the claimant or by making a disabled claimant return to work no matter the treatment risks or if the claimant is actually ready and able.  Several factors are taken into account by the insurance companies when determining appropriate care.  Knowing these factors and what to look for can allow you to receive the appropriate care from professionals of your choice rather than that dictated by the insurance company.

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Monthly Mailbag: Depression, Chronic Pain, and Logistics

We often get questions from people who have called or e-mailed us to take advantage of our free consultations that prompt great discussions of issues common in many disability claims.  Some of these wouldn’t justify an entire blog post, so we’ve decided to put together a “mailbag” of some of our recent questions.  If you have more questions, you can visit our FAQ page or contact our offices.

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Disability Insurance Financials, Part 3 of 3: Other Types of DI

This series on the finances of disability insurance has focused mainly on disability income insurance because it is the most common type of disability insurance, but there are several others that warrant discussion.  In addition to disability income insurance, there are also business overhead expense policies, key-man policies, and buy-sell policies.  Agents offer these policies as stand-alone products or as part of a disability risk management plan for business owners and other individuals who are vital to the everyday well-being of the company.  These highly specialized policies each have their own separate rules and are taxed accordingly. Continue reading