You may be asked to provide a list of your pre-disability duties and hours compared with your post-disability duties and hours. That is, what you did prior to disability and what you are doing now. This is one area that can make or break your claim.
The insurance company pays you for five months and then stops. What are your rights? What should you do? Roll over and play dead, consult a consultant, or consult an attorney?
Objective vs. subjective symptoms. Can the pain be measured or is it related to what you tell someone? Example: You tell your physician you feel nauseous. That's subjective. You throw up in front of your physician. That's objective. Do different insurance companies have different attitudes in this area? Can you do something to help your claim?
A buyout! A person representing the insurance company comes to your door, often unannounced, "dangling" a check in front of you. Should you grab the bait or just mouth it with the option of spitting it out? Should you accept this check and give up your claim, as well as your insurance policy? If you don't accept, should you accept it in round two, in round three?
And, how much should you accept should a buyout appeal to you? Do you know what key advantage there is for the insurance company if you should accept?
What should you expect a disability-claims consultant to do?
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 chiropractic adjustments. 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 were 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.
Arthur L. Fries, RHU, is a disability claim consultant providing advice on a national basis. He is located in Nipomo, CA, and can be reached at 1-800-567-1911. Website: www.afries.com. E-mail:
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