Disability Insurance Claim Advice
Why you should consider hiring a disability claims consultant
RDH MAGAZINE, February 2020
By Art Fries
Why the need?
Would you go to court without an attorney? Would you file a tax return without the help of a CPA? Most of you would answer no to these questions.
But, what if you have a disability claim? Are you prepared to go up against the seasoned insurance company claims person who will handle your claim? Probably not. Enter the disability claims consultant.
Although few in numbers, they cost no more than other professionals who provide a service that you so readily need and deserve. Their job is to help you secure a monthly benefit and solidify your disability claim for the future. These benefits can involve a substantial amount of money, often running into millions of dollars. How do you think your disability claim will be handled? What is the reality versus your expectations?
Services provided by disability claims consultants
Your consultant will send you a copy of the audit and discuss the details with you. This includes contractual wording that considers the definition of total disability as well as partial disability. It is very important to know if you can work in another business that does not conflict with your medical issues, and if earnings from that business will affect the monthly benefit paid. Some policies will allow that, and others will reduce the benefit as it relates to a total disability definition. Your consultant will discuss pertinent policy wording that will have an influence on the amount of money that you are paid.
Your consultant will let you know when to call an insurance company for claim forms. Calling too early can jeopardize your rights. You will be advised on how to complete the forms, which include not only the claimant’s forms but those that must be completed by the attending physician. You will be advised on which doctor will complete the form and exactly how that form should be completed for high success rate of approval.
Understand most people who complete the attending physician’s statement (APS) - whether it's their doctor or someone in their doctor's office - have not taken a course on how to complete these forms. They do not know the definition of total disability or the difference between the various disability wordings as they relate to personal policies, group, association, workers’ compensation, state, or Social Security disability. They must be taught, and your disability claims consultant can provide them with that education through you, the direct communicator with the doctor’s office.
It is important that forms be completed correctly and with credibility. Just one error by you or your doctor’s office can prevent you from being paid. Does the insurance company want more than one APS completed by all of your doctors? Does your policy (or policies) say anything about this point? Your consultant can advise you how to respond to this issue.
The consultant will advise you as to what is considered proper medical care, and when to seek that care.
In addition to the claim forms, the consultant will prepare you for the additional documents that relate to tax returns and other documents that are required.
When approved or even before, the insurance company will want you to provide continuation forms, including one from your attending physician containing different wording, and this will also require advice.
The consultant will also provide advice related to video surveillance, a visit by a field representative to your residence and how to handle an IME independent (medical evaluation/exam) by the doctor assigned by the insurance company. Sometimes, an FCE (functional capacity evaluation) is allowed by policy language, but often it is not. This is a test, usually by a physical therapist, that can take several hours and may determine how much “beating up” parts of your body can take.
There are various questions related to your disability claim that require accurate answers and often cannot be answered by the agent, broker or association who sold you the policy (or policies). Some companies like to offer a “buyout” of the claim after it has been approved. The consultant should be able to provide advice in this area as to what is a fair figure What activities can you participate in "post disability"? Do you like to golf, ski or play tennis? Will these be in conflict with your medical issues?
The consultant can help you prepare additional documents that may not be asked for but help to clarify your claim as it relates to hours worked and the medical history that prompted you to seek disability benefits.
Disability claims consultants will reduce your anxiety and pave the way so that you have the best chance of successfully collecting on your disability claim. It is their job to present you in the best possible light so that you do not have to seek legal recourse because you failed to recognize the valuable services provided by a disability claims consultant.
Art Fries, RHU, is a disability claims consultant providing advice on a national basis in the U.S. He is located in Nipomo, California. He can be reached at 800-567-1911 or firstname.lastname@example.org.