John B. Dupree, Attorney at Law

Knoxville Lawyer for ERISA Relief

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713 Market Street

2nd Floor - Cate Building

Knoxville, TN 37902

865.437.5081

Archive for the ‘Quick Pointers’ Category

Top 5 Things to Remember About Disability Claims

Wednesday, May 11th, 2011 | Quick Pointers | No Comments

If you have filed a disability claim with an insurance company, here is what some disability attorneys would say are generally the most important things to remember:

1) Know What You Have to Show to Get Your Benefits.

If you don’t have a copy of your policy or summary plan description, you will not know what you have to show in order to be eligible for benefits. Also, you will not know what exclusions and limitations might be problematic for your claim. If you do not have a copy, go get your policy from the insurance company or your employer.

2) Check the Insurance Company Calculations.

Sometimes the insurance company will miscalculate the benefit that is due under the policy. Look at the policy and make sure they did it right. You also might have to obtain some of your pay records in order to be sure that the underlying numbers are correct. I once found a claim that had been miscalculated to the tune of an extra $1,000.00 per month.

3) The Less You Can See of Your Medical Condition, the Harder It is to Get Your Benefits.

I once had an old insurance defense attorney tell me, “I pay for blood and broken bones.” What he was telling me was that insurance companies like to be able to “see” the injury. Over time, adjusters and others in the insurance industry become cynical because sometimes claimants exaggerate their injuries, or are dishonest about pre-existing conditions or just make up an injury and make a claim for the resulting alleged pain. So it is a lot easier for an adjuster show that a correct claim decision was made if he or she can point to an MRI, or refer to a blood test or show some other objective test that leaves no question about the nature of the disability. From time to time, an independent auditing company will come in and review the claim files to make sure that everything is going the way it should with the claims. This auditing company will be paid a lot of money to perform this service. Now, how do you think the paying client would react if the auditing company failed to find anything wrong with the claim files? These auditing companies feel that they need to justify their existence – so even if the claims are adjusted correctly, they are going to find SOMETHING. Quite naturally, when the auditing company is looking for a scapegoat to justify its existence, this makes adjusters and their supervisors a little nervous. Hence, medical conditions that cannot be seen will be under more scrutiny. This does not mean that the condition is not real, it just means that the adjuster will look at it harder.

4) You Are Either Disabled or Not. Period.

There is no such thing as “halfway” disabled under your normal disability policy. Of course, there is always a “partial disability” benefit, but I have never seen an insurance company pay such benefits. Someone may be out there collecting these benefits, but I have never seen it happen. From what I have seen, if you can raise your head off of a pillow, you can work a full time job according to the insurance companies. So, in my opinion, a disability claimant needs to sit down with his or her family and consider whether there is any meaningful employment that can be performed by the claimant. If not, then perhaps it is time to make a claim for total disability. Most disabled claimants want to work but simply cannot given their medical conditions. If that is the case, then make a claim for the benefits that you are due.

5) Remember That Insurance Companies Have No Soul.

No matter how many commercials you see that might that try to convince you that an insurance company is such a cuddly and nice entity, it is still a COMPANY. It has a fiduciary obligation to its investors to maximize its profits. That means getting premiums and not paying claims. You’re not in good hands and you won’t have a good neighbor.

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John B. Dupree, Attorney at Law

713 Market Street

2nd Floor - Cate Building

Knoxville, TN 37902

Email: john.dupree@knoxtnlaw.com

865.437.5081 Phone

865.437.5082 Fax

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