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December 2016 Archives

Key Tips in Navigating the Health Insurance Claims Process

Attorney, Alicia Paulino-Grisham was interviewed by the Alliance for Eating Disorder Awareness regarding the health insurance claims process. In the interview, Ms. Paulino-Grisham discussed that many patients and their families often find the health insurance claims process extremely complicated and frustrating. Accordingly, Ms. Paulino-Grisham provided a comprehensive analysis of the health insurance claims process and provided essential tips for patients and their family members to remember when faced with the necessity of filing a claim for eating disorder treatment coverage. Ms. Paulino-Grisham explained that understanding the process and providing the right information to the insurance company early can mean the difference between a claim approval and a claim denial. To see Ms. Paulino-Grisham's interview, click the following link: https://www.youtube.com/watch?v=Hqpl8del8rY.

Don't be Caught Off Guard by Video Surveillance Footage During a Disability Insurance Claim

Insurance companies frequently use private investigators to place claimants under surveillance while "investigating" a claimant's right to disability insurance benefits. Surveillance is conducted at various stages in the disability insurance process including, when a claim is filed, periodically throughout a claim if benefits are approved, and after a claim has been denied. Very often, the activity actually captured on video is not inconsistent with a claimant's stated activities. However, frequently, insurance companies will piece together snapshots of activity, over the course of several days and/or months to create the illusion that the claimant is more active than they have asserted. Private investigators have the power to turn on and off their camera while surveilling a claimant. This gives them significant power to create the illusion that the claimant is less limited than he or she previously claimed. For example, private investigators only shoot footage when the claimant is actually active. If the claimant fails to leave their home for two or three days, the video footage will never capture this, despite the fact that it may be consistent with the claimant's stated limitations and compelling evidence of disability. Similarly, video surveillance footage cannot establish the degree of pain a claimant was in when engaging in the activity seen or document the amount of pain medication the claimant had to take when he or she returned home.

The Fundamental Flaw in Utilizing CPT Codes to Analyze a Physician's Pre-Disability Occupational Duties When an Insurance Company "Investigates" a Disability Insurance Claim

For years, insurance companies have aggressively marketed their disability insurance coverage to physicians, specifically targeting "specialists" with attractive "Own Occupation" protection. They induced physicians to purchase disability insurance with liberal definitions of Total Disability, such as "the inability to perform the material and substantial duties of Your Own Occupation," explaining that if they could perform the duties of an alternative occupation, even one within the medical community, but could not continue to engage in their previous occupation, they would be eligible for benefits. The most coveted of these policies specifically protects the ability to engage in the physician's actual specialty. However, many physicians have found that the promises made to them when they purchased the coverage were not honored when they actually became disabled.

Disability Insurance Law Group Successfully Overturns Standard Insurance's Denial of Disability Benefits for Accountant with Multiple Sclerosis

Our client, Mr. D was a partner at a large accounting Firm for 9 years. Unfortunately, he began to experience severe and debilitating symptoms and was ultimately diagnosed with Multiple Sclerosis ("MS"). Mr. D had difficulty accepting the diagnosis and sought a second and third opinion. Unfortunately, both physicians confirmed that he suffered from MS. As reality set in, Mr. D fell into a deep depression. With the help of his family, his therapist, and his MS specialists, Mr. D overcame his depression and focused on his family, his work, and maintaining his health.

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