Making a disability claim can be a stressful event for your client. They may call on you for your support. These 10 things can help you be prepared for those calls.
1. Listen, Ask Questions And Take Copious Notes
Ask the nature of the accident or illness and the onset date (this is important). Most policies have a 90-day elimination period. Even if the 90 days have not passed, advise the client to file now if there is any chance they won’t return to full-time work making the same money they were making previously, before the 90 days are up. Let your client know it’s best to file a claim via email, not phone. Every step of the claims process should be documented. This initial notification must include the information noted previously and a contact number. Include the client’s name and policy number in the email subject line.
2. Prepare For The Phone Interview
The next step after the notification is the telephone interview. Advise your client to focus on what they are no longer able to do, not what they think they might be able to do. It can be difficult for clients to describe themselves as disabled, but they are disabled for now, so they must be in that mindset. Clients often torpedo their own claims by being reluctant to be seen as complaining. Encourage them to complain. They need to accurately describe how they are feeling and not put a positive spin on it.
3. Create A Record
The interview and the requested documentation to follow are similar to the underwriting process. Advise your client to obtain the email address of the claims analyst during that call. After that call, and any phone call, suggest your client send an email that states something like, “Thank you for your time today. You asked me to send you X, and you committed to do Y.” Creating this record is important.
4. And Keep More Records
I suggest clients keep a diary of sorts, recording every exchange with anyone regarding their claim. This would include exchanges with you and with their medical providers. If anything about the claim is contested, this log of information can be important.
5. Get Ready For A Letter
After the telephone interview, the client will receive a long and wordy letter from the insurance company. Let them know to expect this. It’s the analyst’s job to quote contract language and ask for a whole bunch of stuff.
6. Get Out Those Tax Returns
In that letter, your client will be requested to provide three years of complete tax returns, not including the year the onset date occurred, and year-to-date income information. This is a good thing. The analyst will use this information to benchmark your client’s highest or average income. This benchmarked income number will be used to calculate a residual loss if and when the claim is not a total disability. The reason why this is a good thing is if your client has been ill for some time prior to filing a claim, it’s likely their income has gone down. It’s to their advantage to provide this historical income documentation to show how much they were earning before they became ill or injured.
7. Explain The Accumulation And Elimination Period
Suggest that as part of your client’s diary, they document any day or half-day they didn’t work because of their accident or illness. It could be a day off for diagnostic testing or a day they didn’t work because they weren’t feeling up to speed. Explain to your client how the accumulation period works so they can see why this information is important to record.
If the policy has a 90-day elimination period, the client typically has a six-month accumulation period. That means they can use any day from the onset day for the next six months to accumulate the 90 days they need to satisfy their elimination period. The 90 days do not need to be consecutive.
8. Don’t Use The Mail
When your client sends anything to the insurance company, don’t send it through the mail. Email it, fax it or send it via an overnight delivery service with an indirect signature required.
9. Medical Records Needed
As in the underwriting process, your client’s medical records will be ordered. Advise your client that it’s important to return the HIPAA release to their analyst promptly. Missing medical records seems to be the top reason claims determination is delayed.
10. Do The Right Kind Of Follow-Up
I would advise you to limit your involvement in the claim to nonmedical issues such as following up on medical records, working with a CPA to prepare financial records, etc. Those are things we are qualified to help with. Remember — if you do get involved in claims and things go wrong, you can be called to provide legal statements, so keep good notes of conversations you had with anyone regarding the claim and do the same kinds of follow-up emails as mentioned previously.
It’s always rewarding to help a client navigate the disability claim to a positive outcome.
Lynn Christofferson joined the insurance industry in 1987 with New England Life, now known as MetLife/Brighthouse, to work as a personal producer, and in 1991 moved to Guardian to become a disability income supervisor. In 2008, she joined Truluma as a disability income specialist. Lynn may be contacted at [email protected]