Don't Fish For Disability Trouble

Life is really strange sometimes. We were reading the paper last Sunday when we came across an insurance company advertisement which struck us as relevant to the insured as well.

The full page ad for Chubb Insurance pictured a lone fisherman in a rowboat placidly fishing on a quiet lake. His back was to a nearby waterfall towards which he was drifting. The caption was “Who insures you doesn’t matter. Until it does”. The unwritten message was “Buy your insurance from Chubb or you may face consequences when a claim made against you.”

It really caught our eye because it applies as much to what we try to tell claimants as it does to what the insurance company tries to sell, i.e., “Disability income insurance claimants don’t need experienced legal help, until they do”. Unfortunately, by then it may be too late.

We sound this warning time after time, not just because we are in the business, but because having done disability income claims work for 30 years, we know most all of the pitfalls and traps set before a claimant by insurance companies. (They always come up with new ones which even we haven’t seen yet).

The worst part for claimants is that the biggest trap is laid right at the start of the claims process. While most people, including attorneys not experienced in ERISA and disability income claims, believe an initial claim form is just a notice that a claim is to be made, in reality, the first disability claim form must be accurate and contain complete information necessary to support such a claim.

Failure to properly notify the carrier of a claim will certainly lead to a denial of the claim and be used by the insurer to attack the claim throughout the appeal proceedings. Any misstatement or omission will be thrown up again and again by the company in an attempt to impugn the claim. Full details and accuracy are a must, starting with the first claim form.

A checklist of data which should be included, is:

* Complete details of the injury or illness upon which ther claim is based.
* Complete description of the claimant’s job duties.
* The claimed medical reasons why claimant can no longer perform those duties.
* Full hospital and physician reports to support the claim.
* Occupational testing which supports the claim.

Leaving out or making a mistake on any of the above will be cited over and over throughout the proceedings as proof that the claim is unfounded and should be denied.
It is difficult enough to try to establish a disability income claim. Why make it even harder by giving the insurance company a home run on your first pitch?

Just as the insurance company advises (although unwittingly):
You don’t need an experienced disability claims lawyer…until you do!






Practical Way To Cut Medical Costs

There are a lot of reasons for the high cost of medical care in the U.S., many of them having to do with the cost of evolving cures for formerly incurable illnesses, miraculous drug treatments and the fact that people are living longer these days.

We don’t want to suggest potential cures for these kinds of seemingly insoluble problems, but we do have some basic, common sense thoughts which could still save a lot of money while streamlining the medical system.

The idea came to us while we were reading a study by the Weill Cornell Medical College, the University of Toronto and the Medical Group Management Association, which concluded that U.S. physicians and their staffs spend almost four times more time dealing with health insurers and health payers, than do doctors in Canada. This additional administrative time is figured in the fees charged to patients and their insurers.

The study calculated that if U.S. doctors had administrative costs similar to their brethren in Canada, the savings in health dollars to the U.S. would about $27 billion. This might seem like a pittance when compared to the overall health costs in the U.S., but we have to start somewhere and this is an area which does not touch on the quality of treatment. It just makes sense.

Canada has a single payer health system. If we don’t want to have such a system in the U.S., there certainly should be no objection to uniform forms which document services and medical necessity and provide treatment summaries to minimize the administrative burden on the doctor’s office staff. Rather than having to “recreate the wheel” every time an insurer asks for information, the use of standardized formats by all carriers will make it easier for the doctor’s office to comply with the request and to comply in a timely, cost effective manner. Like anything else, when you repeat the same procedures over and over again, you become familiar with them and it becomes easier for you to fill in the information on a familiar form.

Insurance companies should be expected to jointly design a series of reporting forms for U.S. doctors which sets forth the information the insurers need while providing doctors and their staffs with a user-friendly, standard record to complete.

Such standardized forms, devised by the insurance companies themselves, should be used by every health insurer so that once doctors and their staffs become familiar with them, it will take less time and effort to complete them, and to do so correctly the first time.

Why is this important? Because the study found that doctor’s nurses and medical assistants spent more than 20 hours a week per doctor on tasks related to health insurance plans, more than 10 times that spent by the same staff in Canada.

Evaluation of the time spent by senior office administrators and clerical staff told the same story – substantially more time spent in U.S. offices than in Canada. If time is money, and it is, then it is easy to see that administrative waste is eating up a much larger chunk of the medical pie here than it is in Canada.

If health insurers, whose profits are soaring these days, would cooperate and spend the time and effort required to devise standardized reports, it would cut down on the heavy administrative costs doctors pay their staffs (and charge patients for), while streamlining the medical reimbursement system.

Such a move should save appreciable money and maybe a few bucks would fall off the table for patients. What a concept!