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
Posted in Doctor Visit
- Tagged appropriate care, claim denial, claims process, Disability, disability claim, disability insurance, doctor, examiner, IME, Independent medical examination, Insurance, insurance company, Medical record, surveillance, tips
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
Posted in Best Practices
- Tagged benefits, claim denial, claims process, disability claim, disability insurance, examiner, filing a claim, Insurance, insurance company, lyme, Medical record, reources, tips