Turn Back the Clock!

- by Tim Louis

Many times over the last fifteen years, when meeting with clients who have been denied long term disability benefits by their insurance company, I have wished I could turn back the clock. 

Between the time when they were first denied benefits and their appointment with me, much time and many decisions had been taken. 

If only the client had seen me in the first few days after the original denial. Here are just two examples of where my advice early on would have resulted in a speedier resolution of the claim in my client's favour.

MORE INFORMATION

Quite frequently the insurance company makes the original denial appear much less negative by combining it with a simple request for additional information.

The unsuspecting claimant goes about obtaining the additional information, more often than not at considerable time and expense, only to wait an unacceptable length of time for a response from the insurance company, which, when it finally arrives, is not positive but is a follow-up request for further information. 

On and on the process goes with each information request cycle consuming many months of time, during which the claimant remains without the benefits to which he or she is entitled. 

In my office I always file a Writ in court immediately upon being retained and follow up with the insurance company's requests for further information afterwards. This sends a very clear message to the insurance company that we mean business. 

More importantly, it begins a process which results in a trial date being assigned which brings pressure on the insurance company. Suddenly, the tables are turned and delay no longer benefits the insurance company.

ACTIVITY REPORTS

Very few doctors or lawyers, other than those familiar with ME and FM, are aware that most patients experience great variations from one day to the next in how they feel and in what they can do; that activity one day may result in "crashing" the next few days; and that a good day may seem like a "gift from the gods" to be taken full advantage of. 

Along comes the insurance company with a questionnaire to be completed regarding activities you are able and/or have done in the last year. No request is made for how often and with what consistency you were able to do these activities. Can you vacuum? You answer yes. Can you mow the lawn? You answer yes. Can you sit at a keyboard and work at your computer? You answer yes. And on and on the questions go. 

By the end of the form, you appear to be much more capable than you really are. The last time you were capable of vacuuming may have been months ago, but the form didn't ask for comment on frequency or how long ago you did the task. The same goes for the lawn and the keyboard. 

In my office, I don't let my clients complete the form if it will misrepresent their situation. Instead, the client and I provide full and complete answers to the questions including frequency and impact on my client of engaging in the activity (eg. "crashing".)