Disability Insurance Claim Advice
25 Questions to Ask Before and After Your Client Files a Disability Claim
Health Insurnce Underwriter (N.A.H.U.), August 2002
By Art Fries
Acting as your own advisor can be economically devastating in today’s disability claim environment. Just as your clients would seek the advice of an attorney on a legal issue or the advice of an accountant on a tax issue, they should seek competent advice when faced with the prospect of a disability claim. An experienced disability claim consultant with a successful history of selling disability insurance and providing advice on DI claims can help answer difficult questions and help your client prepare to communicate effectively with insurance companies. These are questions that your clients may not be prepared to answer, yet each addresses an important facet of a DI claim.
- Are you a danger to yourself and to those you give advice to by continuing to work?
- Must you first be totally disabled for 30, 60 or 90 days or more before you can file a partial (residual) disability claim?
- Can you continue your practice or business in some way even when you go on claim?
- Is it better to sell your practice or business before or after the effective date of your claim?
- Should you build up your business or practice before you sell it?
- If you sell your business or practice and go on a total disability claim, can you come into the office? If so, what can you do in a work scenario?
- What is the best way to transition from a partial/residual claim to a total disability claim?
- What are considered to be your substantial and material duties?
- What is considered your occupation?
- When will an insurance company say that you have dual occupations?
- What does it mean when your policy says you are totally disabled if you can’t perform the substantial and material duties of your occupation and are not working in any other occupation? Does this working have a different effect before age 65 as compared to after?
- What would you do if the insurance company asked you to photocopy every page of your office appointment book for the 12 months prior to your disability and the three months after?
- If the insurance company asked you to submit photocopies of every page of your personal and corporate tax returns for the five years before the disability, would you consider the request reasonable? Would your answer be different if you had a total disability instead of a partial disability?
- If an insurance company field investigator came to your home of office and asked you to sign a statement he or she had prepared, how would you handle it?
- If the insurance company asked that its doctor examine you in the form of an independent medical evaluation, how would you prepare the examiner and yourself for the exam?
- How would you respond if the insurance company asked you take a functional capacity evaluation given by its physical therapist?
- If your claim had been approved, how would you respond if the insurance company asked you to complete a monthly progress report and have your physician complete an attending physician statement every month? Are there ways to reduce the paperwork and still give the insurance company information it needs?
- How do you handle your social life (sports, entertainment, ect.) after you go on a total disability claim?
- How do you interpret policy contractual language such as pre-existing conditions, fraudulent misstatements, prudent man clauses, incontestability, rehab presumption of disability, etc.?
- How do you communicate with the insurance company if it offers to buy back your policy and give you a lump sum of money in lieu of paying you a monthly benefit?
- When does an insurance company perform video surveillance, for how many days and for how long?
- Are economic or licensing issues considered by an insurance company?
- How do you know when the insurance company has made a mistake? How do you bring it to their attention?
- Do state insurance departments "swing any weight" in getting your claims paid?
- If the claim is terminated, what are your options?
Do You Want to Get Involved in Handling DI Claims?
The foregoing are just some of the questions that your clients will have to deal with if they go on a partial or total disability claim. For the following reasons, you may want to think twice about being involved in a disability claim:
There are many forms to complete – initially and on an ongoing basis. In addition, many of the questions you and your client will be required to answer demand a very thorough understanding of the subject matter. The importance of answering the questions correctly cannot be overstated.
There is always the potential liability of giving advice in an area that may be "over your head."
Many hours of work are usually required. Helping with the initial claim form is only Round One.
Becoming involved in DI claims distracts you from the selling activities from which you earn your compensation. Once your client’s claim is approved, you no longer receive a renewal commission.
You may be giving simplified advice when your clients need major-league advice.
Not understanding the meaning of words as they apply to a DI contract can also cause you to prejudice your client’s rights. For example, what’s the real meaning of "pre-existing condition?" Does the wording "fraudulent misstatement" change the above? Does the state in which the insured resides have a "statue of fraud"? Does such a statue have any bearing on the claim?
Finally, and most important, do you know how to show your clients how to maintain dignity, self-respect and credibility in their relationship with an insurance company?
A disability claim consultant may be the best investment your clients can make in successfully and effectively submitting their disability claim.
A longtime NAHU member, Arthur Fries, RHU, is an independent life and health broker and disability claim consultant in Newport Beach, CA. Formerly a producer in sales of DI to attorneys and physicians, Art no longer actively sells insurance and now focuses on providing claims consulting. He can be reached at (800) 567-1911. For information about selecting and interviewing a DI consultant, visit www.afries.com.