In our last post, we finished our
discussion regarding the investigation and evaluation stage of the
disability insurance claims process. Hopefully, once you have submitted
the required information and your claim has been evaluated, the
insurance company will approve your benefits. This post discusses the
various steps that need to be taken, following the approval of your
claim, to ensure that you continue to receive your disability benefits.
WHAT HAPPENS IF YOUR DISABILITY CLAIM IS APPROVED
Once the insurance company completes
its investigation and evaluation of your claim, it will issue a decision
either to pay benefits or to deny the claim. Hopefully your claim is
approved. Nonetheless, although a claim approval is good news, it does
not end the claims process, because disability insurance claims are
administered on a month-to-month basis. Consequently, even after your
claim has been approved, you will be required to submit information so
that the insurance company can evaluate whether you are still entitled
to disability benefits. Here are some of the typical actions you can
expect the insurer to take as part of its ongoing evaluation:
Continuing Claim Forms.
Insurance companies require that both you and your doctor continue to
complete and return statements verifying your disability. Typically, and
especially at the beginning of the claim, these reports must be
completed every month in order to continue receiving your disability
benefits.
Periodic Interviews.
Even after the claim is approved, insurers will often require that their
insureds submit to periodic field interviews, either over the phone or
in person, to monitor your activities and to look for inconsistencies
with prior interviews.
Surveillance.
Insurance companies periodically renew surveillance of insureds without
warning, to look for inconsistencies between your reported restrictions
and limitations and your actual activities. The insurance company will
look at the statements made by insureds on their continuing claim forms
or in interviews in connection with the surveillance, both in order to
identify potential surveillance opportunities and to determine whether
they can construe the videotaped activities as inconsistent with your
reports.
Peer to Peer Calls.
As explained in a previous post, another common tactic insurance
companies employ is to have their in-house medical consultants contact
your physicians to find out more information about your condition and
treatment. Although this may seem innocuous on the surface, the
insurance company’s consultant will often question the appropriateness
of the care your doctor is providing. The consultant will also send your
doctor a summary of the call, which often starts out as an accurate
reflection of the call, but then will have information that is harmful
to your claim, and which was never discussed during the call, buried in
the body of the letter. If your doctor does not catch the inaccuracies
and signs off on the summary, the insurance company can use that as a
basis for terminating your claim. An experienced disability lawyer can
help you limit the direct contact an insurance company may have with our
clients’ physicians.
Medical/Occupational Evaluations.
Just like before your claim approval, an insurer can require that you
submit to an Independent Medical Examination (IME) at any point.
Although these are supposed to be conducted by independent physicians
and therapists, the doctors who perform these evaluations often earn a
large percentage of their income from these insurance companies. Consequently, it is important to thoroughly prepare for IMEs and take a witness, preferably a doctor or experienced disability attorney, with you to the IME.
For more information on the disability insurance claims process, visit our website, www.disabilitycounsel.net or take Ed's CE, Disability Insurance Roulette: Why Is It So Hard to Collect on My Policy?
Each dentist’s claim for disability benefits involves different facts, disabling conditions, policy requirements, insurance companies, etc. While our attorneys are making an effort to share general knowledge with the dental community and answer dentists’ questions, this not a substitute for individualized advice from an experienced disability insurance lawyer. If you would like to speak with our attorneys and have them take an in-depth look at your particular situation, please feel free to contact us directly.