How to prepare doctor clients for the disability insurance claims process

James Crook
preparing for the disability insurance claims process

When it comes to the disability insurance claims process, being prepared is vital.  While some insurance brokers may possess advanced knowledge of the intricacies involved in preparing for a claim and in navigating the process when a client has an unexpected disability, effectively communicating this crucial expertise to their clients can be a challenge.

This is particularly important for brokers who serve doctors and other healthcare professionals. Fortunately, there’s plenty that brokers can do proactively to refine their communication skills, enabling them to better help their doctor clients prepare for disability scenarios and make the difficult situation easier should it arise.  In this blog post, we’ll share insights on how brokers can improve their ability to convey this knowledge to their healthcare providers if an eventual disablement or injury occurs.

Why disability claims for doctors can require an extra level of expertise and guidance

The first step for a broker to take in the claims prep process is to gain an understanding of why disability claims for doctors are different than claims for most workers:

  • Doctors often have one or more individual disability policies for which they are also filing a claim; the processes may be different for each claim filing.
  • Doctors are often treated by a fellow colleague (a “buddy doctor”) who may, or may not, have kept detailed records.
  • Doctors may not understand their employer’s critical role in providing detailed information to the claims examiner regarding payroll records, the claimant’s material duties, procedure codes, etc. Some of this information may not be required by their individual disability insurance claims examiner.
  • Doctors are often paid using very complex production formulas. They may also be a partner or shareholder with distributions that need to be accounted for. Forensic CPAs are often needed to accurately determine a claimant’s pre-disability and disability earnings.
  • Doctors are highly educated in the field of medicine, and they may feel their “expertise” regarding their disabling condition outweighs that of the claims examiner; the claim discussion can easily become adversarial.
  • Doctors are often unaware of actions they may take (or refuse) while disabled that can reduce, or terminate, their disability benefit payment:
    • Working outside their occupation.
    • Requirement to work part-time, if able.
    • Requirement to work to their “maximum capacity.”
    • Requirement to undergo rehabilitation and retraining.
    • Restriction on residing outside the United States.
  • Doctors are also insured by medical malpractice carriers who may have an interest that is not aligned with the disability carrier – i.e., incentivizing a disabled doctor to return to a limited surgical schedule may cause concern for their medical malpractice carrier, who is at risk if the doctor performs poorly and is sued by a patient.

Educate clients on the differences between the short-term and long-term disability claim processes.

Once a broker understands the unique characteristics of disability insurance claims for doctors, they can help their clients understand the types of claims that can be filed and their associated timelines.  These include short-term and long-term disability benefits.  Short-term benefits are generally for periods of up to a year, and long-term disability benefits can last until retirement age.

The short-term disability (STD) claim process includes these characteristics:

  • STD claims usually have a short waiting period before benefits begin, which can be as short as a few days or up to a couple of weeks.
  • Short-term disability policies often use a more lenient definition of disability, meaning that a claimant is considered disabled if they cannot perform their “own occupation” due to illness or injury.
  • The short-term disability claims process generally requires less extensive medical documentation, as the condition causing the disability is expected to be temporary.
  • STD claims are less complex and require fewer ongoing evaluations, as the duration of the benefits is relatively short.

The long-term disability (LTD) claim process is more complex than the STD process:

  • Long-term disability benefits typically start after the STD period ends (if the claimant has an STD policy) and can last for several years or until the policyholder reaches a specific age, such as 65.
  • LTD claims typically have a longer waiting period, often referred to as the elimination period, which can range from 30 to 180 days or even longer.
  • Long-term disability claims require more comprehensive medical evidence and review, as the insurer needs to establish that the claimant is unable to work for an extended period or indefinitely.
  • LTD claims often involve more extensive management, including periodic reassessments and potential vocational rehabilitation efforts to help claimants return to work.

Outline the medical documentation needed to support a claim and help your client gather it.

Once a client understands the different types of disability claims and their associated timelines, it’s important to explain what medical documentation is required to support a claim.  This can include doctors’ notes, hospital records, lab results, and other evidence that supports the claim for disability benefits.  Brokers should provide clear guidance on how and when this information must be submitted.

It’s also helpful to suggest that clients keep copies of all medical documentation, including any ongoing treatments they receive.  This will ensure they have the necessary records if a disability claim is ever filed. Additionally, brokers should provide resources to their clients that help them understand what types of medical evidence are required in each type of disability claim.

Finally, brokers should emphasize the importance of providing complete and accurate information to ensure clients receive the benefits they are entitled to as quickly as possible.  Clients should be informed that omissions or misrepresentations may delay or deny them their rightful benefits.

These discussions should start long before a claim is on the horizon.  Brokers who proactively prepare their clients for a potential claim establish themselves as experts.

Provide tips for communicating effectively with insurance companies. 

In addition to understanding the types of disability claims and their associated timelines, clients should also learn how to communicate effectively with insurers during the claims process.  Brokers can provide helpful tips on how to best interact with insurance companies.  This includes explaining that medical information must be accurate and complete and reiterating that any misrepresentations or omissions may delay or deny the claim.

It’s also important to provide clients with an understanding of the claims process and what they can expect during each step. For example, clients should know that insurers may ask for more information as part of their review, including evidence of income or other records to help them verify eligibility for benefits.  Furthermore, brokers should advise their clients to be proactive and to provide any additional information as soon as possible, helping to ensure that the claims process runs smoothly.

Both the broker and claimant should stay in regular contact with the insurance company to monitor the progress of a claim.  This ensures there are no delays or miscommunications and allows them to seek assistance if needed.

Overall, brokers should emphasize the importance of communicating with insurance companies during the claims process.  This will help ensure that clients receive their disability benefits quickly and efficiently.

Highlight resources available to help clients prepare for interviews and meetings with insurance company representatives.

In addition to providing tips on communicating effectively with insurers, brokers should also provide resources to help their clients prepare for meetings and interviews with insurance company representatives.  Knowing what to expect during these interactions can reduce stress and anxiety, which is important for any disability claimant.

Brokers should direct their clients to materials such as guides on preparing for a disability claim interview and what questions might be asked.  They should also point their clients toward resources such as disability advocacy groups, which can provide additional support and guidance throughout the claims process.

Offer guidance on the claims appeals process.

Finally, brokers should be prepared to provide guidance on the appeals process if a claim is denied. Clients should know that they have the right to appeal the insurance company’s decision and receive information about their options.

Brokers should prepare their clients at the beginning of the claims process for a potential negative decision.  This way, if a negative decision is reached, the claimant knows what steps they can take.

Brokers can help by explaining the available appeals types, such as in-person hearings or written submissions.  They should also provide guidance on how to prepare for the appeals process and what evidence may be needed to support their claim.

Ultimately, brokers should emphasize the importance of patience throughout the appeals process, as it can sometimes take months before a decision is rendered.

As a benefits broker, it is important to ensure that your client is prepared for the disability claims process. By providing them with information on how to distinguish between short-term and long-term disability claim procedures, educating them on what medical documents are necessary for a claim, teaching them how to interact with insurance companies and imparting tips to help prepare for interviews and the appeals process, you can help guide your client through the often difficult process.  While each case will be unique, having this knowledge can lighten your client’s burden as they go through the process of filing a disability claim and provide reassurance they have the skills required to advocate for themselves throughout this difficult time.

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