Disability Insurance Claim Advice
The Disability Insurance Claim... Smooth Sailing or Nightmare?
Southern California Psychiatrist (So. Calif. Psychiatric Society), July 1998
By Art Fries
You may pay $1,500 to $4,000 or more per year to insure several cars, and if you get into an accident (whether it's your fault or another's) there is an attorney to provide advice. Or, if your house burns down or you have a partial fire loss, there is a "public adjuster" to represent you, for a fee. But what happens when you "burn out" in the form of a sickness or accident and you have one or more disability insurance policies in force? Most people just complete the claim forms, provide a form to the attending physician, and expect the monthly claim checks to start flowing.
"Going it alone" in today's disability claim environment can prove to be economically devastating. Wouldn't it make sense to secure the services of a consultant to help you submit your claim so you won't prejudice your rights, as well as present your claim to the insurance company in a clear fashion? Unfortunately, there is a shortage of talent in this very important area, but there are a few individuals willing and able to provide the advice you so badly need —for a fee, of course.
A consultant will charge an hourly rate applied against a minimum retainer fee that will be affected by the number and type of disability policies as well as the complexity of the claim. Because your claim may involve several million dollars of potential benefits, you will want to select the right individual for the job at hand.
Once hired, what should you expect the disability claim consultant to do?
1) Review all policies including copies of original applications.
2) Review any diagnosis/prognosis reports from physicians that provide insight into your medical history which has created the claim.
3) Help you answer the questions on the claim forms or any questionnaire.
4) Provide advice on how to communicate with your attending physician.
5) Determine if you have a total or a partial (residual) claim.
6) Determine if your claim relates to your occupation or your earnings.
7) Advise you on how to handle visits by claim investigators, CPAs, as well as visits to Independent Medical Evaluators.
8) Advise how to prepare a list of your pre- and post-disability duties, broken down hourly and weekly.
9) Where you have more than one disability policy with various wording, help you to determine what you can and cannot do with respect to post-disability duties.
10) Provide advice on the meaning of exclusions provisions and earning clauses, if applicable, and a host of other contractual wording.
A disability claim consultant can also be available to you after you have already submitted the documentation for your claims, but are having problems collecting from the insurance company, or have been terminated.
A disability consultant should also be able to help you develop a strategy in connection with your claim. There may be a recommendation to bring in another consultant in the form of a CPA, another physician or other professional, to help straighten your claim. You or your attending physician or others might have prejudiced your rights unknowingly, resulting in a weak claim or one which the insurance company denies altogether.
It's depressing enough to be on disability, and an adversarial attitude on the part of the insurance company employees or those hired by them is not going to reduce your pain or your symptoms. Shouldn't you have the same expert advice afforded by your disability claim consultant to counteract the expert advice now being provided to many of the insurance companies?
Often the disability claim consultant will be able to provide advice to attorneys where the services of such an individual is appropriate to your claim. And sometimes the consultant will suggest that you seek the services of an attorney.
In today's claim environment, seek the help you so readily need ...the disability claim consultant.