Expediting a Short Term Disability Claim
Why Patients Must be Actively Involved in the Insurance Claim Process
Jul 21, 2009
The percentage paid by the disability insurance company varies anywhere from 50% to 75% of the employee's salary. Some large employers may offer 100% short term disability pay. It's best to find out prior to going out on disability how much one will be reimbursed.
In the event of a short term disability claim, it is important to understand the how the claims process works and know the names and contact information of the individuals involved.
Key Players in a Short Term Disability Claim
When it comes to having the names and contact information, the employee must have the following information:
- Name of insurance company, policy number, policy term, phone number and if possible, the name of the claims person handling the claim. Most likely there won't be one dedicated person handling the claim, but make sure to jot down the name of each person contacted when discussing the claim.
- Name and phone number of the Human Resources representative at the employee's company. The HR contact can help to facilitate the claims process.
- Name and phone number of the doctor and the doctor's assistant. More than likely for purposes of claims processing, the doctor's assistant will be the point person.
- In some cases, the employee who is filling the disability claim may be unable to handle the phone calls and paperwork necessary to process the claim. In such cases, the employee must appoint an authorized representative. In doing so, the employee must give authorization to the insurance company to divulge claims information to the authorized representative.
Causes of Disability Claims Processing Delays
Unfortunately short staffed insurance companies do not have the employee power to continually make phone calls to follow up with the doctor or the doctor's staff to obtain the necessary information. Some insurance companies make two to three attempts to obtain the patient's updated information. If the information is not received, the insurance company will contact the insured and notify him of the inability to further process the claim.
The physician's office may not be providing the information for the same reason the insurance company is unable to continually follow up for the necessary documentation. The physician's office too may be short staffed and over worked. In today's economy many offices are running on skeleton staff with each employee having a doubled or tripled workload.
Expedite the Claims Process
It is up to the patient or patient advocate to take the lead position to ensure the timely processing of the claim. The patient has the most to lose if anything falls through the crack. After all, if the insurance company does not issue the disability claim check it's the patient's financial standing that is in jeopardy, not the doctor's office or insurance company staff. Therefore it is important to take the lead role to ensure a timely claim processing.
It may become necessary to place daily phone calls to both the insurance company and the physician's office to ensure that information is being communicated properly and the necessary documentation is transmitted from the physician's office to the insurance company. A delay in submitting the required information to the insurance company may lead to a denial of the claim. Once an insurance company denies the claim it is difficult and time consuming to get them to reverse the decision.
Bottom line, the patient must be an integral part in the claims process to ensure that he receives the necessary payments while out on disability.
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