Preparation is key and getting your claim(s) approved is the whole game!
Once you know you’ll need to file claims for long-term disability (LTD) benefits, learn and compare the definitions and coverage of each policy so you can plan the best claim-filing strategy.
The number of disability claims has increased in recent years as Baby Boomers are now between the ages of 48 and 66. As the number of claims has increased, insurance companies have become more conscientious in handling LTD claims and especially those of high net worth professionals where, in the long run, there are literally millions of dollars in benefits at stake. . Given these facts, what steps can professionals take to minimize or eliminate the possibility of their disability claims being 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 increased substantially. Between 70 and 80 percent of his $825k annual income was attributed to invasive procedures that he performed primarily on intensive care patients. As his income increased, he in turn purchased additional disability income protection insurance.
However, at age 58, he developed carpal tunnel syndrome in his dominant left hand. He underwent surgery, but after 8 months the condition returned and he no longer had the dexterity or manipulative precision to maneuver the instruments needed to perform invasive procedures.
What Dr. Sharpe should consider before filing your claim(s)
1. Over the years, insurance companies issue new policies due to changes in the industry and consumer needs. Therefore, while the policies may be similar in many respects, it is unlikely that the provisions of your three policies would be identical.
2. READ each policy carefully, especially the limitations and exclusion provisions! Make sure you clearly understand how each policy defines disability, as some may have more than one definition. Understanding how these different definitions can affect each other and benefit eligibility is key.
3. Filing claims is a complex process. The dense legalese of these lengthy contracts, multiple definitions, limitations and exclusions, numerous riders often mean that even though Dr. Sharpe read them carefully or even multiple times, he had no idea that a “payment” could end up being limited. , or even not -exist – when it’s time to file a claim.
4. Be aware and aware of potential claim tactics:
- Particularly when it comes to high liability claims, keep in mind that before approving claims for payment, insurers carefully review all the facts from the inception and throughout the life of the claim. Expect insurance companies to monitor claimants as they go about their daily business. Claimants can make a single mistake without suspecting it, and that single incident leads to problems that jeopardize the claim for benefits.
- It is the claimant’s responsibility to find out the details and details of what is needed to successfully file claims. Dr. Sharpe is a Cardiologist, he has no knowledge of the “ins and outs” of the claims process. How could he know what it takes to confirm disability? Claimants like Dr. Sharpe unsuspectingly fall into traps that result in claim denials.
- Independent medical evaluations by (so-called) independent providers unsurprisingly generate biased opinions often favorable to the insurer. What can Dr. Sharpe do to be better prepared for such an evaluation?
To protect your interests, Dr. Sharpe should consider hiring a Long Term Disability Claims Consultant (LTDCC) before filing your claims. He helps level the playing field and increases the likelihood that your claims will be approved.
Given the complexity of his situation, and with significant long-term disability benefits at stake that could easily exceed more than a million dollars, he felt it would be to his advantage to retain the services of a disability claims consultant to better understand:
- the definitions of disability in your policies
- what documentation would be needed to support your claim of total disability as a cardiologist who performs invasive and non-invasive procedures.
- If the definitions of disability in his 3 policies differed, what is the best strategy to use to ensure that he is eligible for benefits under each policy or policies that provide him with the most benefits?
- that as the claims process progressed and new claims and information were made, a disability claims consultant in your corner could help ensure you didn’t make accidental mistakes that jeopardized your benefit claims.
Having a professional long-term disability claims consultant in your corner helps level the playing field.