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November 15, 2009 at 07:00 PM
Imagine yourself going into a battle with a firecracker as your chief weapon and being confronted by an opponent with a hydrogen bomb at their disposal. Or, going to trial without the benefit of an attorney.
In today’s disability claim environment the typical scenario is that of David (the policyholder claimant) going up against GOLIATH (the insurance company). To create a more equitable balance, a disability claim consultant can offer assistance in the way of advice. This includes how the claim forms should be completed and helps to present your client’s claim in a clear and concise fashion to the insurer. 
In addition, there are issues related to how your clients conduct themselves in communicating their disability to their physician, how to handle a field claims representative and how to conduct themselves should the insurer request an I.M.E. (independent medical evaluation) or F.C.E. (functional capacity evaluation).
Your client may think he has a residual (partial) claim from an emotional standpoint but in reality has a total disability claim from a contractual standpoint. There are issues related to objective symptoms vs. subjective symptoms. As an example, the claimant told the physician he felt nauseous. That’s subjective. If he then “threw up” in front of the physician that would be objective! Some claims may lean very strongly toward subjective symptoms yet be quite disabling in terms of doing the material duties of the job.
How would your client handle a request by the insurance company that he see a rehabilitation specialist when the contract provides a “your occupation” definition?
In past years, disability claim forms asked limited questions and insurance companies paid claims in a rather routine fashion. Because of mounting losses, many insurance carriers have made major adjustments in their claim departments. In addition, they utilize the services of C.P.A.s, psychiatrists, physicians with specific backgrounds, field investigators, video surveillance and other investigative agencies to analyze the claim to a finite degree.
Today, many claims are being denied because “going it alone” leaves the policyholder (claimant) at a serious disadvantage. Although you may think you, as a producer, know a lot about disability insurance, you may not be equipped to provide advice in terms of the knowledge and effort required on your part.
