The new year is always a good time to review the events of the past 12 months and see what you can do to improve your life over the next 12 months. If you’re dealing with health problems and a resulting disability insurance claim, this is also a great time to review the status of your claim and find ways to make the claim process stronger, simpler, and better. This can be done in whichever stage of the claims process you’re in. Whether you are still considering filing a claim, are waiting on a decision from the insurance company, are receiving benefits, or are facing a claim denial, it’s important to stay on top of your claim. Insurance companies are always looking for new strategies to increase profits and reduce claims, so you should always try and stay one step ahead of them. These 10 ways to protect your claim can help reduce your stress and work required on your disability claim over the next 12 months. Like most things, maintaining a strong disability claim is easier than rehabilitating a claim when it breaks (or is denied).
- Know your policy and industry definitions. Before you begin to file your claim or fight back against the claim examiner’s decisions, you must know the specifics of your policy and the different terms and requirements in the policy. This will give you the knowledge and background to better understand what the insurance company is telling you as well as making sure you know all of benefits for which you’re eligible. For example, knowing whether you have an own-occ or an any-occ policy, as well as whether and when the definition changes during the benefit period, is vital to receiving your proper benefits.
- Help your doctor help you. Your doctor visits and the resulting medical records are the most vital aspect to any disability claim. Make sure your doctor understands what you need and how to properly fill out the confusing forms provided by the insurance company. Often, doctors don’t have the time or desire to keep up with all of the required documents, so your doctor will appreciate your organization and assistance in this regard, which will also allow you to understand and monitor the documentation for your claim.
- Create a thorough and complete medical history. Having a medical history document is good advice for anyone, not just those filing a disability claim. However, there are many uses for keeping it updated while filing a claim for benefits. Having an updated medical history on hand allows doctors to quickly find significant events in your medical past as well as your current medication and treatment regimen. This can be especially useful when seeing a new specialist for your condition or attending an independent medical examination (IME).
- Follow all physician recommendations and watch out for “appropriate care and treatment” requirements. While alternative treatments and medications are helpful for many different conditions, it’s important for a disability claim to follow the treatment regimens provided by your medical providers. All disability policies require that “appropriate care” be obtained for a condition, and insurance companies (such as UNUM) have been known to use these clauses to deny legitimate claims. Make sure you’re seeing specialists appropriate for your condition, especially mental disorders. Even if alternative treatments are working and helping with your condition, your attending physician must document traditional treatments along with any alternative treatments in your medical records.
- If possible, stay away from a residual disability claim. If your disability policy differentiates between residual disability (which is sometimes labelled proportionate disability) and total disability, it’s to your advantage for your claim to be considered total disability, especially in own-occ policies. Many disability insurance companies will try to reclassify a disability claim as residual to reduce their reserve and save money. The claim process is also much more demanding for a residual claim than a total claim. You can protect against this practice by completing a detailed, through and complete job description and making sure your supporting documents clearly show that your restrictions and limitations prevent the performance of your material and substantial duties.
- Be wary of insurance company surveillance. Another common tactic insurance companies use to deny claims is surveillance. They hire third-party private investigators to capture video evidence that’s often misconstrued to dispute your impairments and terminate your benefits. From contacting your friends and neighbors to invading your privacy, some private investigators will use creative and unprofessional (and even borderline unethical) tactics to get the information they’re hired to get.
- Watch out for the dangers of social media. Social media is great for staying in contact with friends and loved ones, but it can also provide information a claims examiner will use against your disability claim. While the Internet and social media provide access to massive amounts of data and information, taking this data out of context allow an innocent post or story to be twisted into a basis for the insurance company to deny your claim.
- Reel in an aggressive claims examiner. Much of the interaction with your disability insurance company comes through the claims examiner assigned to your case. These examiners are trained to use many different tactics to get the information they want, but you are not required to cower or panic if they seem to become aggressive. There are many counter-techniques you can use to stay in control of the situation and make a claims examiner respect you and your requests. Allowing unreasonable demands and attitudes to continue unchecked can cause undue stress in your life and lead to problems in your claim.
- Make sure your claim follows ERISA rules, if applicable. Group long-term and short-term disability policies are subject to ERISA that limits when information can be provided and set specific deadlines. If your disability claim is covered by ERISA, it’s very important to follow these rules while filing your claim. This is even more important for those who are filing an appeal of the denial of their claim. ERISA is rather technical and must be followed strictly in these cases.
- Never take no for an answer. This is probably the most important thing for anyone with a disability claim to remember. Disability insurance companies rely on people accepting their denials or being bullied into dropping their claims. Many denied claims are approved on appeal – as long as the insured bothers to prepare and file a strong appeal. In addition, it’s important to defend your rights and not let the insurance company dictate what you do in your life. If you’re truly disabled, you shouldn’t have to cater your daily behaviors and reduce your life to the expectations of a claims examiner. It is possible to get a fair decision – as long as you’re prepared to work through the claim approval process.
Every year it seems the disability claim process gets more difficult for claimants and more creative by insurance companies. The beginning of this year is no exception. Our firm has already seen companies, such as Standard and UNUM, using at-best questionable claims tactics to terminate claims that have been paid for years. We’re also beginning to see claims denied that would have been approved in prior years. Each one of these ten points provides a link to more extensive information about each idea, and I hope that all claimants thoroughly read this information if they intend on maintaining the disability benefits they deserve. The insurance companies are becoming experts at delaying and denying legitimate claims, so take control of your future and don’t be reduced to a statistic.
If you are worried about going through the claim process alone or have further questions about your disability insurance policy, please call our offices toll-free at (855) 828-4100 or visit out website to sign-up for a free consultation.