Would you go to court without an attorney? Would you file a tax return without the help of a certified public accountant? Most people would answer no to these questions.
But what if you had a disability claim? Would you be prepared to go up against a seasoned insurance company claims person assigned to handle your claim? Probably not. Enter the disability claims consultant.
Although few in number, the job of these people is to help you secure a monthly benefit and solidify your disability claim for the future. 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 the 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 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 in other areas 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 a high success rate of approval.
Understand that 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 differences in 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 your doctors? Does the policy (or policies) say anything about this point? Your consultant can advise you on 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 any other documents that are required.
When approved, 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 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” some 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 conflict with your medical issues?
The consultant can help you prepare additional documents that may not be asked for but will 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 did not recognize the valuable services provided by a disability claims consultant.
Art Fries, RHU, is a disability claims consultant who provides advice on a national basis. He is located in Nipomo, California. He can be reached at (800) 567-1911 or [email protected]. Visit afries.com for further information.