Summary: Last month’s checklist began addressing claims under disability income insurance, business overhead insurance and perhaps disability buyout insurance. This month will provide a few more tips and discuss steps those struggling with their disability companies, and their advisers, can take. Reporters interested in exploring what appears to be a rather significant problem are provided great sources at the end of this checklist.
√Authorizations. Don’t provide the carrier with an open ended authorization to obtain whatever information they wants. Some authorizations are unreasonably broad. Instead endeavor to reasonably limit authorizations to what is appropriate and necessary. The business overhead carrier will need different information than the disability income carrier. Revoke existing authorizations if they are too broad or are being abused. Ask for copies of all documents obtained on your matter from the insurance company. If they won’t confirm what documents they requested inquire in writing why. Remind them that financial and other confidential information about you should not re-disclosed to the extent feasible (certain data may have to be).
√Physician Calls. Your physician will get a “peer to peer” call. They might be really busy and not focused if the call comes during the middle of their office hours. This is the same issue as with emails above. Quick answers may just be wrong. If your physician states something incorrectly it could be used to undermine your entire case. Then the insurance company can deny your claim. Consider restricting your physician to only releasing selected data and not speaking on the phone. This should be noted prominently on your patient file.
√Symptom Worksheet. Prepare a symptoms work sheet and fill it out and provide it to your physician at each visit. Your physician may not have adequate time during a routine office exam to record this level of detail and the insurance carriers may need detail to make determinations. A quick comment in your chart like “stable” might be so general and vague that it is simply inaccurate. But it could be a basis to deny your claim.
√Remember Home Mortgage Securitization? So you bought a policy from an insurance company with a household name. You pay premiums for years relying on the reputation of the company in case you need ‘em. Years later when you file a claim you learn that the well known company sold your policy (they’ll call it “reinsured”) to a Chinese company who hired a private US company to administer it. When the name brand insurer has no interest in your policy, will it really be administered in the manner you anticipated when you purchased it? Even your agent may have no clue what has transpired. Hasn’t the fundamental nature of the agreement made when you purchased the policy been violated? Some type of disclosure standard, at minimum, should be considered to address this.
√Monitoring or Pressuring. If you have a progressive chronic illness what purpose is served by a disability company continually requesting reports from your neurologist? Chronic progressive illnesses don’t improve. While one can understand the desire for periodic updates at a reasonable interval, does a substantial increase in requests for data occurring at the same time you have a dispute with the insurer, or are negotiating a buyout, suggest something inappropriate? Reasonable regulation of this process should do nothing to harm insurers protecting their legitimate interests, but it might well give the struggling disabled some protection. How about a recent add directed to the disability insurance industry: “Do you know what your claimants are doing around the upcoming holidays? Find out now at a discounted price. Capture that active claimant on video! An all-inclusive day of surveillance for a low flat rate of: $499.”
√How to Buy Disability Coverage. If you’re in the market for buying disability coverage, do it right. Most folks focus on premium costs. You’re not buying hamburger! The real shopping you should do is to pick the right agent. Get an agent that really knows the product, and who will stick with you and help you if you have issues later. That’s the smart way to shop.
√Few Options. What does it mean when a nationally known insurance consultant doesn’t want to bother filing a claim for obviously incorrect actions by a disability insurance carrier with the state insurance commission because he knows nothing will be done? When industry leaders are so jaded another approach is called for.
√Join the Task Force. The Insurance and Financial Planning Committee of the RPTE Section of the American Bar Association is organizing a task force to explore disability insurance issues, with an emphasis on developing goals and framework for possible state legislation and regulations. One perceived problem is the lack of transparency in the operations of this industry, and the need for consumer oriented regulation. An end product might be a white paper that will be presented to NCCUSL to initiate the process of drafting a uniform law. For info contact David S. Neufeld, Esq. 609-919-0919, David@DavidNeufeldLaw.com
√Reporters. Reporters seeking more information on these issues should contact: ■ Jennifer Jaff, Esq., Advocacy for Patients with Chronic Illness, Inc., (860) 674-1370, firstname.lastname@example.org■ Bonny G. Rafel, Esq. Livingston, New Jersey (973) 716-0888 email@example.com .
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