Your insurer may mail you a disability benefit check for less than the stated benefits in your policy. What are the proper protocols to appeal that payment – or your entire claim? Is it possible the insurance company misunderstood the documentation that you provided? The potential complications are endless and the dollars that you have not been paid can become enormous.
You may have every intention of returning to work but cannot be sure what will happen to your disability benefits if your level of work is deemed to be other than part-time. What if you cannot sustain the nature and extent of the your pre-disability work load? Could returning to work jeopardize the continuity of your disability benefits? What about continuity of the other fringe benefits provided by an employer – will the return to work jeopardize or cause a change in employment status?
Not getting the answers you need from your disability insurance company is frustrating and discouraging. Most claimants, after completing their claim forms, will immediately and unknowingly prejudice their rights.
Most attending physicians, even with the best of intentions, also will prejudice your rights and will not even know it because they have never been educated about the difference between a Workers’ Compensation claim response and that of an individual or group disability benefit claim.
You should be aware of the exposures presented by:
- Independent Medical Evaluations (IME)
- Unannounced visit by field investigators
- CPA visits
- Video surveillance
- Home office or consulting doctors calling your attending physician
- Errors by brokers or agents
What Royal Claims Advocates can do for you:
- You may think, from an emotional standpoint, that you have a partial (or residual) disability claim, but from a contractual standpoint, you have a total disability claim.
- Advise you on how to communicate with your physicians so that they know the implications of their answers on a disability claim form.
- Advise you on what to expect and how to handle an Independent Medical Evaluation (IME) or Functional Capacity Exam (FCE).
- Advise you on what to expect and how to handle field representative visits, surveillance, forensic accountant reviews, occupational rehabilitation consultants, gainful employment assessments and other techniques used by the disability insurance company to deny claims.
- Advise you on how to fully describe your pre-disability versus post-disability duties and hours. TThis could make a difference between you collecting nothing, something, or all of your monthly benefits.
- 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 disability claim, but for some types of benefit claims, they may not.
- Help you decide if a buyout can be to your disability benefits or detriment and what is reasonable in the way of an offer by the insurance company.
- Review your disability policy, including the original application for coverage.