The Disability Claim Consultant

Why the need?

By Arthur L. Fries

 Would you go to court without an attorney? Would you file a tax return with the help of a CPA? Most of you would answer no to these questions. But, what if your client has a disability claim? Are they prepared to go up against the seasoned insurance company claim person who will handle their claim?

Enter the disability claim consultant.

Although few in numbers, they cost no more than other professionals who provide a service that your clients so readily need and deserve. Their job is to help them secure a monthly benefit and solidify their disability claim for the future. These benefits can involve a substantial amount of monies often running into millions of dollars.

How do they think their disability claim will be handled? What is the reality versus their expectations?

Following is a list of the services provided by a disability claim consultant:

  1. Prepare a written audit of the claimant’s disability policy(s) on forms that have been specially designed for that purpose. Send them a copy of the audit and discuss the details with them. This will include contractual wording that considers the definition of total disability as well as partial disability. It is very important to know if they can work in another business that is not in conflict with their medical issues and also if earnings from that other business will affect the monthly benefit that is paid. Can they continue their practice or business and hire another person and still collect the full monthly benefit? Some policies will allow that and others will reduce their benefit as it relates to a total disability definition. The consultant will also discuss pertinent policy wording in other areas that will have an influence on the amount of monies that are paid.
  1. Tell your client when to call an insurance company for claim forms. Calling “too early” can jeopardize their rights. When the forms are received they will be provided advice on how to complete the claim forms, which includes not only the claimant’s forms but those that must be completed by the attending physician. They will be advised on who will be the doctor to complete the form and receive advice as to exactly how that form must be completed in order to enjoy a high success rate of approval. Understand that anyone who completes the physician’s form (APS), whether it be their doc or someone in their office, has never taken a course on how to complete these forms. They do not know the definition of total disability or the difference between the various disability wording as it relates to personal disability policies, group, association, workers’ compensation, state disability or Social Security disability. They must be educated and the disability claim consultant can provide them with that education through the claimant, the direct communicator with the doc’s office. It is important that forms be completed correctly and with credibility, and just one error by the claimant or their doc’s office can prevent them from being paid. Does the insurance company want more than one APS completed…by ALL their docs? Does the policy(ies) say anything on this point? The consultant can advise on how to respond to this issue?
  2. The consultant will provide advice as to what is considered proper medical care…and when to seek same.
  3. In addition to the claim forms, the consultant will prepare the claimant for the additional documents that are required that relate to tax returns, procedure codes (for professionals) and other documents that are required.
  4. When approved or even before, the insurance company will want the claimant to provide “continuation forms” as well as from their attending physician with different wording that will also require advice.
  5. The consultant will also provide advice related to video surveillance, a visit by a field representative to the claimant’s residence as well as advice on how to handle an I.M.E. (Independent Medical Evaluation/Exam) by a doctor assigned by the insurance company. Sometimes, an F.C.E. (Functional Capacity Evaluation) is allowed by policy language but often it is not. This is a “test,” usually by a physical therapist, that can take several hours and may determine how much “beating up” parts of the claimant’s body can take.
  6. There are various questions that the claimant will want to ask related to their disability claim that require accurate answers and often cannot be answered by the agent, broker or association who sold the policy(ies).
  7. Some companies like to offer a “buyout” of the claim after it has been approved. The consultant should be able to provide advice in this area as to what is a fair figure and what isn’t.
  8. What activities can the claimant participate in post disability? Do they like to golf, ski and play tennis? Will these be in conflict with their medical issues?
  9. The consultant can also help the claimant prepare additional documents that may not be asked for but help to clarify the claim as it relates to the hours worked and the medical history that prompted the claimant to seek disability benefits.

In essence, a disability claim consultant can reduce your client’s/claimant’s anxiety and pave the road so that they have the highest chance of success as it relates to collecting on a disability claim. It is their job to present the claimant in the best possible light so that they do not have to seek legal recourse because you or they failed to recognize the valuable services provided by a disability claim consultant.

Art Fries is a disability claim consultant providing advice on a national basis in the U.S. He is located in Nipomo, California. He can be reached at 800-567-1911 or