UNUM Success Story!

A 56 year-old surgeon, suffering from arthritis and lumbar disk problems, had become uncertain whether he could remain in a surgical suite for sufficient periods to complete all of his surgeries. To compensate for his chronic pain, he reorganized his responsibilities to assisting on some surgeries and doing more clinical work, including pre- and post-op patient visits. He was in a multi-physician practice that was able to accommodate his changes by rearranging duties and work schedules.

The surgeon bought a UNUM disability insurance policy in the early 1990’s that provided for $12,000 of monthly benefits and had faithfully paid his premiums. Since he was no longer performing most of his surgical procedures due to his pain and weakness, he realized the only way he could maintain his income would be to file a disability claim with UNUM. The office manager of the practice contacted their insurance agent, who referred her to the claims department. Claim forms were obtained, completed, and submitted.

After almost 75 days of repeated telephone calls and letters back and forth, UNUM denied his disability benefits due to ambiguity in the symptoms, unclear medical proof of the claimed conditions, and an unduly broad inclusion of occupational duties.

A mutual friend mentioned our firm to the very upset and frustrated doctor. After calling and meeting, he decided to engage our firm to go through the documents that were already submitted to UNUM. We worked with the doctor to prepare a much stronger, more detailed, and clearer disability claim. After working with the insured, his practice manager, and his attending physicians, we were ready:

  • Complete and detailed descriptions of his occupational duties were prepared.
  • Additional tests were performed to document the claimed conditions.
  • A clear and fully documented history of his disabling conditions was written.
  • Letters were written explaining the errors that were made in evaluating the originally submitted claim.
  • Claim forms were completed again with the additional, more complete, information.

Finally, all of this information was compiled and presented in a manner that was easy for the claims examiner to review and accept…which is exactly what happened!

Our client started receiving his monthly disability benefits within 2 weeks, plus 9 months of retroactive benefits. His only regret is that he didn’t use our firm from the beginning! His benefits are still continuing today, more than 7 years after starting his claim. Of course, we’ll check in or he’ll have questions from time to time – as the claims process never stops. But, he’s been able to collect on the promises made when he made the wise decision to protect his income in case of disability.

This case is just one of the many examples why you should never give up when an insurance company denies your disability claim. With the standard operating procedure of “question then deny,” many companies exhaust their insureds into giving up when they get the dreaded denial letter. With our help, clients can easily handle the mass of paperwork and communication the insurance companies use as weapons to deny claims.

We welcome and encourage your comments on this blog. If you would like to add your own experiences, please share them!

Really, it’s a “win-win” ?!?

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.

Filing a Disability Claim

Filing a disability claim is an emotional process.  While many people have disability coverage, no one wants to use it and few people are aware of the time-consuming and humbling process insurance companies use to validate your claim.  Many insureds feel helpless and upset but unsure of how to respond.

We understand this fear, and our experiences in the insurance claims defense industry provides our team with the expertise and knowledge to help you exercise your rights as the insured.  The insurance company entered into a contract with you — and you have a right to make sure they abide by that contract and keep their promises.

The claims process is designed to be intimidating and frightening.  Insurance companies want you to accept how poorly you are treated by insisting that they have the right.  But far too often, they don’t.  Our team knows their tactics and works to ensure that the insured’s rights are protected in every step of the process.  You do not need to fear looking over your shoulder, opening your mail, answering the phone.

We are here to stop the fear and intimidation created by the disability insurance companies.  We are here to make sure that you, the insured, are treated fairly and get the benefits that the insurance company promised when you signed their contract to protect your financial well-being.

For more information on our firm, visit www.RoyalClaimsAdvocates.com.  Also, please feel free to ask any questions or relay your own insurance experiences in the comments.