We have encountered several cases where claimants have been denied their benefits not because of incomplete or inconclusive evidence of their medical conditions but solely because their conditions kept them from working longer than the guidelines used by disability insurance claim departments. When evaluating disability claims, claims examiners rely on industry developed resources to determine the expected duration of the claim, regardless of the specific circumstances. Based on these claim management practices that have been put into place by most insurance companies, we’d like to shed some light on the process used to assign expected return to work dates for claims and the extra steps that claimants need to take to protect their benefits if they’re disabled beyond these arbitrary dates. Continue reading
We have talked previously in our blog about the dangers social media can pose for your disability claim. As summer kicks into gear and many people enjoy outdoor activities and vacation traveling, it’s important to revisit some of the social media points we’ve made in the past and provide some new insight into how different Internet sites may be able to help your claim and improve your odds of obtaining the disability benefits you deserve. 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
ERISA, the Employee Retirement Income Security Act, was enacted in 1974 with the purpose of protecting employee benefit plans, but insurance companies have become adept in using ERISA rules and regs to their advantage. Almost all Short Term Disability (STD) and Long Term Disability (LTD) plans are subject to ERISA, as are some individual plans. ERISA is complicated and has a number of requirements regarding disability claims that both the insured and the insurance company must follow.
Once a disability claim subject to ERISA is filed, evaluated, and denied by an insurance company, the insured either accepts the denial or files an internal appeal with the insurance company. Each step of this process has deadlines that must be carefully followed, or you can lose all future benefits along with your right to appeal or even litigate. It is important to keep detailed records and stay on top of your claim.
Our office recently received a referral from an insurance agent whose client’s employee had filed a disability claim under their LTD policy. She had rheumatoid arthritis and could no longer do her job. The employee’s disability claim had been denied, and they were about to appeal when the agent thought to contact our firm. I am going to lay out some of the mistakes that were made or about to be made and how we were able to fix them, hopefully helping you avoid the same pitfalls. Inadvertent mistakes can happen and can cost hundreds of thousands of dollars in past and future benefits. Continue reading
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!
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.