The Disconnects Between Diagnosis and Disability

One of the biggest issues our clients face when filing their disability claim is the lack of clear medical opinions explicitly linking their condition to their disabling restrictions and limitations.  Physicians are skilled at diagnosing a disease or illness, but they may not be the best at explaining why the condition is disabling for the claimant.  This can especially be problematic with mental illnesses or other types of invisible disabilities.  Any ambiguities cause increased scrutiny and in-house referrals by claim examiners and are often used as a basis for a disability claim denial.  Helping your doctor connect the dots between your condition and your inability to work smooths the disability claims process and fosters a quicker claim approval with fewer questions.  We’d like to discuss two perspectives to this issue: the claimant’s and the physician’s.  We’re going to discuss what each party can do to make the disability clearer and the claims process smoother.   Continue reading

Protect Yourself Against A Functional Capacity Evaluation

In addition to IME’s (Independent Medical Examinations) insurance companies are also known to use Functional Capacity Evaluations, known as FCE’s, to analyze a claimant’s disability.  These evaluations assess the ability to perform a series of tasks which simulate customary job duties and determine the extent to which the claimant can complete these job duties on a regular basis.  FCE’s can have different focuses and purposes and be referred to as Physical Capacity Evaluations, Work Capacity Evaluations, or Disability Assessments, but they all mean the same thing: the insurance company is attempting to use a biased and flawed evaluation system to challenge the statements of you and your doctor about your ability to return to work.   Continue reading

Defending Your Claim Against the Insurance Company IME

The most important piece of evidence in a disability claim is the medical basis for the disability.  If there is strong medical proof of the severity and continuation of your disabling condition, then there’s a good chance of your claim getting approved.  However, this may not always be the case.  Many conditions don’t have clear cut tests to prove their existence, and other conditions have testing protocols that either aren’t generally accepted or aren’t always accurate.  Even if appropriate testing exists, claims examiners may try to dispute the opinion of the attending physician.

When these and other issues are noticed in the claim file and want to be explored, claims examiners will often demand that the claimant undergo an IME.   Continue reading

6 Tips To Keep Your Disability Claim Moving

One of the biggest red flags a claimant can inadvertently create in their disability claim is to move.  While there are many legitimate reasons someone can move, claim examiners have been trained to closely scrutinize a case where a claimant moves.  New sets of arguments and investigative avenues are opened for the insurance company to use against you.  As anyone who’s moved can tell you, moving is difficult at best.  And the last thing someone needs, who is already trying to move while dealing with their disability, are new and additional hassles from their disability insurance company, not to mention the added stress of worrying that their benefits will be delayed or stopped.  If you’re currently applying for or receiving disability benefits, there are several issues we think you should understand as well as a few tips on how to keep the disability claim process moving smoothly during this stressful time.   Continue reading

10 Ways to Protect Your Disability Claim in 2013

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).  Continue reading

Happy Holidays From All Of Us!

From all of us at Royal Claims Advocates to you and your loved ones, we wish you a happy and healthy holiday season!  This blog normally provides you with advice and tips on filing a successful disability claim, but today we’re going to take a break from the normal claims grind – and explain why you should too. Continue reading

Finding The Proper Disability Insurance Policy For You

Many claimants who contact our offices know little about disability insurance.  Some are aware that they have disability insurance and need help, while others don’t even know what kind of policies they have and just happen to find our firm while trying to figure out their next steps.  Most people realize the need for disability insurance but because it’s bundled in group packages from their employer, they have never seen their actual policy and  know little of their coverage rules and limitations.  When the time unexpectedly comes to file a claim for benefits, disability insurance companies capitalize on this lack of knowledge and use it to place some claimants at a significant disadvantage when initially filing their claim for benefits.

However, it doesn’t have to be this way.  Information is available to learn about the risks you face of becoming disabled, different types of policies and options, and how you can protect yourself and your income.  Doing this homework before purchasing a disability policy will help ensure that you have an understanding when you have to file a claim for benefits while you’re disabled along with the comfort that you and your family is protected if something prevents you from earning a living or continuing in your job.  This ounce of preparation will allow you to use disability insurance for its intended purpose:  to reduce the risks of everyday life.   Continue reading

The Battle Between Insurance Companies and Mental Illnesses

Mental illness is on the forefront of much medical innovation and research today.  As we continue to better understand and comprehend the human mind and its illnesses, we’re able to more accurately diagnose and treat many different psychiatric conditions that were either misdiagnosed or simply ignored in the past.  Mental illnesses range greatly in length and severity of the conditions, but they can all be debilitating and render the patient unable to work in their or often, any chosen occupation.  If you or someone you know is suffering from a mental illness and has disability insurance through their employer or individually, you should be able to obtain disability benefits through your policy.  However for reasons I’ll discuss below,  insurance companies unfortunately tend to make this difficult and will vigorously try to delay, reduce, and deny your disability claim due to mental or nervous conditions.  Mental illness has a become a prime target for disability insurance companies, and those souls who are simply trying to collect their benefits have to be prepared for a fight. Continue reading

Around the Nation: News and Insight From Across the DI World

In the past few weeks, there have been some interesting news articles that either impact the landscape of the disability insurance industry or affect how disability benefits may be awarded in the future.  As a disability claim consultancy firm, we accept our challenging responsibility to stay current on industry news and realize that many don’t have the time or ability to keep up with the volume or focus of information.  There are developments in many different fields that can have a direct impact on disability insurance and individual claims, from new medical research to job programs to court decisions.  Taking the time to research our industry allows us to stay current on the best claims presentation and handling processes and updates the ways we interact with our clients and the recommendations we make about their disability claims.  We hope that seeing how we keep our clients up to date on news and developments helps your own decision-making process and builds trust in the disability claim community.  Of course, the only problem is that change and developments never stop.  While these topics were current when this blog post was written, everyday they become a little more outdated.  Please stay tuned for future news and updates.  Continue reading

Succeed Quietly Rather Than Failing Loudly

Working with disability insurance companies for years, the experts in our firm have seen many people and approaches come and go in the industry.  Marketing philosophies clash with claim handling procedures, legal decisions change the language used in policies, insurance companies sell blocks of policies to other companies, management turnover lead to changes in how claims are handled, etc…  To paraphrase a famous line – the more things change, the more they stay the same.

Unfortunately, many of these changes have negative consequences on the claims and lives of insureds.  What may be perfectly acceptable in year two is no longer good enough in year three.  Documentation that’s accepted by one claims examiner is disputed by another.  In spite of this, the underlying fundamentals of disability claims remain the same:  if you have the medical, occupational, and financial information to prove that you are disabled under the terms and conditions of the policy, you are entitled to benefits. Continue reading