Disability Insurance Claim Advice
Twenty Questions To Ask Before You File A Disability Claim
Orange County Lawyer, July 2001
By Art Fries
In today's claim environment acting as your own advisor/expert can prove to be devastating from an economic standpoint. Just as you would seek the advice of an accountant on a tax (accounting) issue you should seek competent advice when faced with the prospect of a disability claim.
A reputable disability claim consultant can help with answers to difficult questions either for your own or your client's case, arid give potential immeasurable aid when dealing with insurance carriers. Insure you ask, then answer; at least the following 20 questions.
1) Are you ["you" refers to you or your client throughout] really a danger to yourself and your clients by continuing to work.
2) Must you first be totally disabled for 30, 60, 90 days, or longer before you can file a (residual) disability claim.
3) Can you continue your practice in some way even when you go on claim.
4) Is it better to sell a practice before or after the effective date of the claim.
5) Should you "build up" your practice before you sell it.
6) What's the best way to transition from a partial (residual), to a total disability claim.
7) If you sell your practice and go on total disability claim can you come into the office. If so what can you do from a work scenario.
8)What is considered your substantial and material duties.
9) What is considered your occupation.
10) When will an insurance company say that you have dual occupations?
11) If your policy says you are totally disabled if you cannot perform the substantial and material duties of your occupation and are not working in any other occupation, what does this mean? Does this wording have a different effect prior to age 65, as compared to age 65 or thereafter.
12) If the insurance company says they want you to photocopy every page of your office appointment book for the 12 months prior to your disability as well as the three months afterward, what should you do.
13) If the insurance company asked you to submit photocopies of every page of your personal as well as your corporate tax returns for the five years prior to disability, should you consider this request reasonable? Would the answer be different if you had a total disability instead of a partial disability.
14) If a field investigator for the insurance company came to your house or office and asked you to sign a statement that he had prepared, how should you handle it.
15) If the insurance company requested that you be examined by their doctor in the form of an IME. (Independent Medical Evaluation), how would you prepare for the exam? Since the insurance company will not send to you a copy of the examiner's report how should you secure a copy of same.
16) If the insurance company requested that you take a F.C.E. (Functional Capacity Evaluation), which is a test given by their physical therapist, how should you respond.
17) After your claim has been approved, if the insurance company requests that you provide them with a monthly progress report as well as an APS. (Attending Physician Statement) completed by the physician (monthly), how should you respond. Are there ways that you can reduce the amount of paperwork in this area and still give the insurance company the information that they need.
18) How do you handle your social life (sports, entertainment, etc.) after you go on total disability claim.
19) How do you interpret policy contractual language such as preexisting conditions, fraudulent misstatements, 'prudent man clauses," incontestability, rehab, presumption of disability, etc.
20) How do you communicate with the insurance company if they offer to 'buy back" your policy and offer you a lump sum of money in lieu of them paying a monthly benefit. These are just some of the questions regarding a partial or total disability claim.
Most important is: How do you maintain your dignity and self-respect as well as your credibility (in your relationship with an insurance company) that may or may not be willing to pay legitimate substantial benefits.