Preparation is Key and Getting Your Claim(s) Approved is the Whole Game!
Once you know you will need to file claim(s) for long term disability (LTD) benefits, learn and compare each policy's definitions and coverage so you can plan the best claim filing strategy.
The number of disability claims has increased in recent years as "Baby Boomers" are now 48 to 66 years old. As the number of claims increased, insurance companies have become more conscientious in the handling of LTD claims and especially those of high net-worth professionals where over the long term, there are literally millions of benefit dollars at stake. Given these facts, what measures can professionals take to minimize or eliminate the possibility of having their disability claim(s) denied?
Let's review the case of Dr. Wade Sharpe who purchased 3 individual LTD policies over the course of his 28 year career as a cardiologist. Once he started a family and gained recognition as a renowned cardiologist, his income substantially increased. Between 70 to 80 percent of his $825k annual income was attributable the invasive procedures he performed primarily on critical care patients. As his income increased, he in turn purchased additional disability income protection insurance.
However, at age 58, he developed carpal tunnel syndrome of his left, dominant hand. He underwent surgery, but after 8 months the condition returned and he no longer had the manipulative dexterity and precision to maneuver the instruments needed to perform invasive procedures.
What Dr. Sharpe should consider before filing his claim(s)
1. Over the years, insurance companies issue new policies due to changes in the industry and consumer needs. So, while the policies may be similar in many ways, it is unlikely that the provisions of his three policies would be identical.
2. READ each policy carefully, especially the limitations and exclusion provisions! Make certain you clearly understand how each policy defines disability as some may have more than one definition. An understanding of how these different definitions might impact the others and benefit eligibility is key.
3. Claim filing is a complex process. The dense legalese of these lengthy contracts, multiple definitions, limitations and exclusions, numerous riders often means that although Dr. Sharpe read them carefully or even several times, he had no idea that a "payout" may wind up being limited - or even non-existent - when it's time to file a claim.
4. Become aware and savvy concerning potential claim tactics:
- Particularly when it comes to high liability claims, be aware that before approving claims for payment, insurers carefully examine all the facts from the onset and throughout the life of the claim. Anticipate that insurance companies conduct surveillances on claimants as they go about their daily activities. Claimants may unsuspectingly make just one mistake and that single incident gives rise to problems that jeopardize the claim for benefits.
- It is the claimant's responsibility to figure out the details and specifics of what is needed to file claims successfully. Dr. Sharpe is a cardiologist, he has no knowledge of the "ins and outs" of the claim filing process. How could he know what's needed to confirm disability? Claimants like Dr. Sharpe unsuspectingly fall into traps that result in claim denials.
- Independent medical evaluations by (so-called) independent providers, not surprisingly, render biased opinions often favorable to the insurer. What can Dr. Sharpe do to be better prepared for such an evaluation?
To protect his interests, Dr. Sharpe should consider engaging a long term disability claims consultant (LTDCC) before filing his claims. It helps to level the playing field and increases the likelihood of his getting his claim(s) approved.
Given the complexity of his situation, and with significant long term disability benefits at stake that could easily exceed over a million dollars, he felt it would be advantageous for him to engage the services of a disability claims consultant to better understand:
- the definitions of disability in his policies
- what documentation would be needed to substantiate his claim for total disability as a cardiologist performing invasive and non-invasive procedures.
- that if the definitions of disability in his 3 policies differed, what is the best strategy to use to assure that he is eligible for benefits under each policy or the policies providing him with the greatest benefits?
- that as the claim process progressed and new information and requests were made, a disability claims consultant in his corner could help assure that he didn't make accidental mistakes that would jeopardize his claims for benefits.
Having a professional long term disability claims consultant in your corner, helps level the playing field.
Source by Vivian P. Gallo