Disability Ins. 2

Summary:
Last month’s checklist began addressing claims under disability income
insurance, business overhead insurance and perhaps disability buyout insurance.
This month will provide a few more tips and discuss steps those struggling with
their disability companies, and their advisers, can take. Reporters interested
in exploring what appears to be a rather significant problem are provided great
sources at the end of this checklist.

√Authorizations. Don’t provide the carrier with an open
ended authorization to obtain whatever information they wants. Some
authorizations are unreasonably broad. Instead endeavor to reasonably limit
authorizations to what is appropriate and necessary. The business overhead
carrier will need different information than the disability income carrier. Revoke
existing authorizations if they are too broad or are being abused. Ask for
copies of all documents obtained on your matter from the insurance company. If
they won’t confirm what documents they requested inquire in writing why. Remind
them that financial and other confidential information about you should not
re-disclosed to the extent feasible (certain data may have to be).

√Physician Calls. Your physician will get a “peer to
peer” call. They might be really busy and not focused if the call comes during
the middle of their office hours. This is the same issue as with emails above.
Quick answers may just be wrong. If your physician states something incorrectly
it could be used to undermine your entire case. Then the insurance company can
deny your claim. Consider restricting your physician to only releasing selected
data and not speaking on the phone. This should be noted prominently on your patient
file.

√Symptom Worksheet. Prepare a symptoms work sheet and fill
it out and provide it to your physician at each visit. Your physician may not
have adequate time during a routine office exam to record this level of detail
and the insurance carriers may need detail to make determinations. A quick
comment in your chart like “stable” might be so general and vague that it is
simply inaccurate. But it could be a basis to deny your claim.

√Remember Home Mortgage Securitization? So you
bought a policy from an insurance company with a household name. You pay
premiums for years relying on the reputation of the company in case you need
‘em. Years later when you file a claim you learn that the well known company
sold your policy (they’ll call it “reinsured”) to a Chinese company who hired a
private US
company to administer it. When the name brand insurer has no interest in your
policy, will it really be administered in the manner you anticipated when you
purchased it? Even your agent may have no clue what has transpired. Hasn’t the
fundamental nature of the agreement made when you purchased the policy been
violated? Some type of disclosure standard, at minimum, should be considered to
address this.

√Monitoring or Pressuring. If you
have a progressive chronic illness what purpose is served by a disability
company continually requesting reports from your neurologist? Chronic
progressive illnesses don’t improve. While one can understand the desire for
periodic updates at a reasonable interval, does a substantial increase in requests
for data occurring at the same time you have a dispute with the insurer, or are
negotiating a buyout, suggest something inappropriate? Reasonable regulation of
this process should do nothing to harm insurers protecting their legitimate
interests, but it might well give the struggling disabled some protection.  How about a recent add directed to the
disability insurance industry: “Do you know what your claimants are doing
around the upcoming holidays? Find out now at a discounted price. Capture that
active claimant on video! An all-inclusive day of surveillance for a low flat
rate of: $499.”

√How to Buy Disability Coverage. If you’re
in the market for buying disability coverage, do it right. Most folks focus on
premium costs. You’re not buying hamburger! The real shopping you should do is
to pick the right agent. Get an agent that really knows the product, and who
will stick with you and help you if you have issues later. That’s the smart way
to shop.

√Few Options. What does it mean when a nationally
known insurance consultant doesn’t want to bother filing a claim for obviously
incorrect actions by a disability insurance carrier with the state insurance
commission because he knows nothing will be done? When industry leaders are so
jaded another approach is called for.

√Join the Task Force. The Insurance and Financial Planning
Committee of the RPTE Section of the American Bar Association is organizing a
task force to explore disability insurance issues, with an emphasis on
developing goals and framework for possible state legislation and
regulations.  One perceived problem is
the lack of transparency in the operations of this industry, and the need for
consumer oriented regulation.  An end
product might be a white paper that will be presented to NCCUSL to initiate the
process of drafting a uniform law. For info contact David
S. Neufeld, Esq. 609-919-0919, [email protected]

√Reporters. Reporters
seeking more information on these issues should contact: ■ Jennifer Jaff, Esq., Advocacy
for Patients with Chronic Illness, Inc., (860) 674-1370, [email protected]■ Bonny G. Rafel, Esq. Livingston, New Jersey
(973) 716-0888 [email protected] .