Disability Insurance Claim Advice
The 10 Most Common Mistakes Made by Disability Claimants
The Chiropractic Journal, July 2011
By Art Fries
Submitting disability claims can be a tricky business, for both doctors and patients. In a previous article for the Chiropractic Journal (Feb. 2010) Arthur Fries discussed whether chiropractors are victims of discrimination when it comes to disability claims. This month, he addresses the most common filing mistakes patients make.
1. Not seeing doctors for treatment or advice when medical symptoms appear. In order to collect on a disability claim a patient must be under the care of a physician. Sometimes that care must be “appropriate” or the doctor must be “appropriate”. Knowing what this different language means can highly influence the individual’s claim.
2. Submitting a claim for total disability while still working, just because the doctor says he or she is totally disabled. Until the person actually STOPS, he or she won’t be considered totally disabled. Some claimants submit the claim before they stop working to see if the insurance company will honor the claim. Doesn’t work that way!
3. Handing his or her attending physician an insurance company form to complete saying, “Doc, I’m going on disability claim. . . you need to complete this form”. This is a very serious mistake. The patient’s doctor may not know the difference between a personal disability claim, a Worker’s Compensation Claim or Social Security disability as it relates to contractual language. Is it a partial disability or total disability? It’s important for patients to communicate with the doctors(s) effectively so they know HOW the medical symptoms affect the person’s ability to work from either a partial or total disability standpoint.
4. Refusing to submit tax returns to the insurance company. The insurance company must make a proper investigation to determine a person’s occupation and earnings.
Tax returns will reveal important information that enables the insurance company to see if the individual has more than one occupation, as well as secure other important information.
On a partial disability it will enable the company to compare pre-to-post-disability earnings.
5. Indicating on a claim from that he or she supervises seven people when, in fact, he or she supervises no one. Most claimants don’t understand the meaning of this question and therefore provide an incorrect answer.
6. Communicating with the insurance company by e-mail. Often this leads to excessive amounts of e-mail going back and forth. There’s a greater opportunity for incorrect statements to be made in this scenario.
7. Faxing a large number of documents to the insurance company. An initial claim (with many documents) should always be submitted to the insurance company by OVERNIGHT MAIL, assuring that someone will sign for them. Since overnight documents can’t be sent to a PO Box, it’s important to make certain the actual street address is used, and that it is correct. When there are just a few documents, it’s okay to mail them. The faxing process takes too much time, and fax quality isn’t as good as the actual documents. Additionally, the proper insurance company department doesn’t always receive all the documents faxed to them.
8. Doubling the salary of his or her office manager spouse to show higher business expenses in order to try and collect more on a a partial disability claim. This must not be done unless the spouse has to work additional hours to meet the individual’s needs.
9. On a partial claim, taking no salary or a small salary on a month by month basis and then in December blasting out with a large salary, bonus, and large contribution to a pension/profit sharing plan. Since the insurance company pays on a monthly basis by comparing pre- and post-disability earnings, the objective is to have low earnings in order to collect more money. By taking a large amount of money in December, the individual won’t be eligible to collect any money that month. Although people think it’s alright since they collected much more the other months, what they don’t realize is that the insurance company will secure the persons’s tax return for that year when he or she files the return the following year and then makes “an adjustment”. The company divides the annual earnings by 12 to get the average post-disability monthly earnings figure. They then compare the total they’ve paid the person in the prior year, and secure the average monthly amount he or she was paid. If too much was paid out, they’ll ask for the money back.
10. Engaging in athletic or other activities that are in conflict with the medical symptoms. It’s important that the individual knows which activities are in conflict and not give the insurance company a reason to deny or terminate his or her disability claim.
There are many other areas related to a disability claim in which mistakes can be made. It’s important to secure competent advice from a professional experienced in these areas. There’s just too much money involved to leave matters to “chance”.