Disability Insurance and Benefit Claims Consulting Services:
Treading into the Unknown Realm of Insurance Companies at a time when you are faced with a potentially life altering Disability Claim can be an Ominous and Humbling consideration for even the most educated and determined Intellectual. Virtually every individual with just such an experience, when first realizing they have just become characterized as a disability claimant, will be at a minimum perplexed by considerable changes and extraordinary hurdles that seems to all jump into your daily life. Challenges and uncertainty all of a suddenly a common thought which previously most would have found inconceivable. Among the most significant is the a dilemma which is frequently described as the fear of the unexpected and unknown.
We at Equitas Disability Advocates do understand!!
At a time when a life has already been severely disrupted by a potentially devastating life event, disability claimants find themselves stepping into the insurance company’s domain. What now seems apparent is that the continuity of one’s financial affairs has become indelibly linked to an insurance company’s disability claims adjudication process - something the claimant knows little or nothing about, and is unsure whether his colleagues and employer are going to be allies or adversaries.
Regardless of the circumstances surrounding the manner in which the claimant acquired and maintained the coverage: whether the coverage was offered on a group basis through a Long Term Disability (LTD) ERISA Welfare Benefit Plan provided in conjunction with your employment or is associated with an Individual Disability Income (IDI) product obtained personally, purchased with substantial premiums which have been paid year after year, either way the process of pursuing your rightful benefit entitlements will indeed be at times seem to involve complex issues.
The reality is that even if the coverage is with a respected insurance company that has a reputation for providing quality disability coverage, the claim process brings the whole subject into a very different and disconcerting light. Under these circumstances for the first time the claimant must face the fact that they really are not sure what insurance benefits they may be entitled to and how to go about getting paid.
Where do you find the most reliable source to answer the many questions that will be presented? Here are your alternatives:
(1) trust the insurance company to pay you fairly, accurately and timely and handle the processing of the claim alone; or,
(2) let your insurance broker who sold the product , who may have assisted with one or two other clients with their claims handle it. How many claims have they been involved with overall and how involved have they been in the lengthy adjudication process? or,
(3) hire an attorney not an inexpensive proposition for what may not be a complex case.
Historically the options have been clearly limited and the downside was the inherent risk of lost benefits. The more years a claim lasts, the more immense the loss of benefits becomes. Who is going to tell the claimant if the amount they have been paid is truly and accurately reflective of their entitlements, if it is in accordance with the formula's for computing benefits the plan says they are entitled to receive? The company mails a claimant a check but it is for less than the stated benefits in your policy or certificate. What is the proper protocol to appeal a claim? Is it possible the Claims Examiner may have misunderstood the documentation that you provided? The potential complications are endless and the dollars that you have not been paid can become enormous.
The claimant has every intension of returning to work but cannot be sure what will happen to his benefits if his level of work is deemed other than part-time. What if they cannot sustain the work load they previously had been capable of or that was a requirement to effectively fulfill the production standards in terms of either the work product output or business revenues levels. What impact will returning to work have upon the benefit payments and how will this real life scenario influence the future benefit entitlement? Could it jeopardize the continuity of future 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 status? Who will assist you in making what could be such a significant assessment?
Not getting the answers that one might need from the insurance company, is frustrating and discouraging. Can any claimant truly be certain that the insurance company representative understands their situation and circumstances that may make the claim unique justifying further consideration. So how does the claimant know if the insurance company representative is experienced enough assess their case. Will they be capable of providing the immediate claims supervisor an accurate and complete analysis, one that correctly portrays what has happened and whether the entitlement is valid.