Disability
Insurance Claim Advice
What
Arthur L. Fries, RHU can do for you.
Advise
you on how to complete the claim forms, line by line, in a way
that honestly and clearly presents your medical problem in the
best possible light to the home office claims person. Most
claim forms that I have reviewed are too vague, with respect
to the answers provided, and could cause doubt in the mind of
the home office claims person. You may think, from an emotional
standpoint, that you have a partial (residual) disability claim,
but from a contractual standpoint, you have a total disability
claim. One type might bury you in paperwork every month... another
may not.
Advise
you on how to communicate with your physicians so that they
know the implications of their answers on a claim form. The
attending physicians always should be truthful, but we don't
want a physician to provide a response that unknowingly blows
your claim out the window.
Advise
you on what to expect and how to handle the IME.
Advise
you on how to set up your pre- vs. post-disability duties and
hours.
The days of just saying you rest, watch TV, and walk the dog
might just not hold up in today's claim climate. This could
make a difference between you collecting nothing, something,
or 100 percent of your monthly benefit.
Advise
you on how to handle a "kiss-off" or termination from the insurance
company. It doesn't necessarily mean you crawl into the
corner in the fetal position, with your thumb in your mouth,
although emotionally that is what you may feel like doing. You
may have a very legitimate claim, but your paperwork has been
lacking in the way of misinformation, or information that is
not clear to the claims department. Or you might have been acting
in a way that would lead the insurance company to think that
you were not disabled by definition, when, in fact, you were.
As an example, you have a major cervical problem that prevents
you from doing surgery/procedures. You have intermittent pain
and a protruding disc that shows up on an MRI. However, you
see no problem driving your five-speed sports car and switching
gears with your "operating arm." This, in spite of the fact
that you might be driving with some pain or difficulty. This,
by itself, might not cause the insurance company to terminate
your claim; but, this, added to several other questionable acts,
might be a reason for doing so.
Advise
you on how subjective symptoms can be converted to objective
symptoms with the proper medical testing. And, some subjective
symptoms by themselves might pose a problem with your claim,
but for some types of claims, they may not.
Help
you decide if a buyout can be to your benefit or detriment and
what is reasonable in the way of an offer by the insurance company.
Review
your disability policy(s) or a photocopy of it, including the
original application for coverage. This should include a
review of the original proposal, provided by the broker . .
. if available. Were the questions on the original application
clear or were they poorly worded? Might the agent/broker have
left out any pertinent information? Might the insurance company
have terminated a claim or denied it because of an omission
or a mistake by the agent/broker? The definition of total disability,
partial (residual) disability, a COLA option and any one of
a number of options, wording, exclusions, etc., will have a
bearing on how your claim is handled.